
n™ ~F C St 



THE 



MEDICAL AND SURGICAL 
COMPANION. 



FOR THE USE OF 



FAMILIES, SEAMEN, TRAVELLERS, MINERS, &o. 



A BRIEF DESCRIPTION, IN PLAIN LANGUAGE, 

OF THE DISEASES OF MEN, WOMEN, 

AND CHILDREN. 



THE MOST APPROVED METHODS OF TREATING THEM. 



A. I. FENN, M.D., 

FELLOW OP THE MASSACHUSETTS MEDICAL SOCIETY. 



*S BOSTON: 

DPUBIUSIIICD BY THE AUTHOR. 
1870. 






NOTICE 



This book can be obtained of the author and agents only. It is 
not for sale in the bookstores. 

Price, neatly bound in line Leather (Library Style), $2.50. 

It will be forwarded by mail, postpaid, to any part of the country, 
on receipt of price. 



Entered, according to Act of Congress, in the year 1870, by 

ARTEMAS I. FEXN, M. D., 

In the Clerk's Office of the District Court for the District of Massachusetts. 



Stereotyped at the Boston Stereotype Foundry, 
No. 19 Spring Lane. 



PREFACE, 



It will be well to remark, in presenting this 
book to the public, that it is not designed to super- 
sede the attendance of a physician, in cases of 
disease, accident, &c, but as a work which can 
be used as a guide, when persons are in any way 
«o situated that they cannot readily obtain the 
services of a medical man. 

Families, seamen, travellers, miners, and others, 
who are often unable, for days, and in some cases 
even weeks, to obtain the aid of a physician, need 
some book to which they can refer for advice and 
guidance, in cases of sudden illness or accident. 

All persons should possess a knowledge of what 
is most proper to be done in cases of accident, 
drowning, hanging, poisoning, bleeding, &c; for 
a person's life, in such instances, often depends 
upon what is done on the instant, and before a phy- 
sician can possibly be called. In preparing this 
volume I have consulted many works of author- 
ity, appropriating whatever seemed to me of 



value ; and have endeavored, within as small a 
compass as convenient, and in as plain a manner 
as possible, to lay down such rules, and give such 
directions, as will enable every one who reads 
them, to adapt to his (or his friend's) case, the 
plan of treatment most proper for it. 

Used for the purpose for which it is designed, 
I trust this book will do no harm, but much good, 
and that it will become a welcome Medical and 
Surgical Companion to many. 

A. I. FENN. 

No. 90 Avon Steeet, Boston, April, 1870. 



CONTENTS. 



PART I. 

PEACTICE OF MEDICINE. 
CHAPTER I. 

ON THE PRESERVATION OF HEALTH. 

PAGE 

Cleanliness and Clothing. — Pure Air. — Food, Drink, Diges- 
tion, &c. — Labor. — Rest. — Recreation and Amusements. 

— Hints to Travellers in Health. — Flannel. — Beds. — 
Water. — Cold. — Hints to Invalids Travelling. — Apotheca- 
ries' Weights and Measures. — Blood Vessels. — The Pulse. 

— General Rules to be observed in the Treatment of Dis- 
eases. — The Sick Room. — The Nurse 1-15 

CHAPTER II. 

FEVERS. 

Of Fever in General. — Simple Inflammatory Fever. — In- 
termittent, or Fever and Ague. — Remittent Fever. — Bilious 
Fever. — Yellow Fever. — Typhoid Fever. — Typhus Fever. 

— Hectic Fever. — The Eruptive Fevers. — Small Pox. — 
Varioloid. — Kine, or Cow Pox. — Chicken Pox. — Measles. 

— Scarlet Fever 16-38 

(v) 



CONTENTS. 



CHAPTER III. 



Acute Rheumatism. — Chronic Rheumatism. — Sciatica. — 
Gout. — Scrofula. — Anaemia. — Chlorosis 39-48 



CHAPTER IV. 

DISEASES OF THE NERVOUS SYSTEM. 

Inflammation of the Brain. —Water in the Head. —Apoplexy. 
— Sun Stroke. — Delirium Tremens. — Insanity. — Head- 
ache. — Paralysis.— Palsy. — Hemiplegia. — Paraplegia. — 
Mercurial Palsy. — Lead Palsy. — Shaking Palsy. — Epi- 
lepsy. — Hysteria. — Fainting. — Catalepsy. — St. Vitus' 
Dance. — Locked-Jaw. — Hydrophobia. — Neuralgia. . 49-70 

CHAPTER V. 

DISEASES OF THE AIR PASSAGES AND LUNGS. 

Acute Catarrh. — A Cold. — Chronic Catarrh. — Clergyman's 
Sore Throat. — Acute Inflammation of the Larynx. — Mem- 
branous Croup. — Spasmodic Croup. — Diphtheria. — Influ- 
enza. — Whooping Cough. — Bronchitis. — Asthma. — Hay 

Asthma. — Pleurisy. — Lung Fever Consumption. — 

Spitting of Blood 71-105 

CHAPTER VI. 

DISEASES OF THE HEART, &c. 

Palpitation. — Angina Pectoris. — Pericarditis. — Endocardi- 
tis. — Blue Disease. — Diseases of the Blood. — Scurvy. 
— Purpura 106-112 



CHAPTER VII. 

DISEASES OF THE ORGANS OF DIGESTION. 

Inflammation of the Tongue. — Aphthse. — Canker. — Thrush. 

— Mumps. — Inflammatory Sore Throat. — Dyspepsia. — 
Pain in the Stomach. — Water Brash. — Vomiting of Blood. 

— Inflammation of the Stomach. — Ulcer of the Stomach. — 
Cancer of the Stomach. — Inflammation of the Intestines or 
Bowels. — Colic. — Diarrhoea. — Dysentery. — Cholera Mor- 
bus. — Malignant or Asiatic Cholera. — Obstruction of the 
Bowels. — Worms 113-138 

CHAPTER VIII. 

DISEASES OF THE LIVER AND SPLEEN. 

Inflammation of the Liver. — Cancer of the Liver. — Jaun- 
dice. — Enlargement of the Spleen. . 139-145 

CHAPTER IX. 

DISEASES OF THE PERITONEUM, OVARIAN DROPSY, &c. 

Acute Peritonitis. — Chronic Peritonitis. — Abdominal Dropsy. 

— Ovarian Tumors. — Abdominal Consumption. . . 146-150 

CHAPTER X. 

DISEASES OF THE KIDNEYS AND BLADDER. 

Inflammation of the Kidneys. — Bright's Disease. — Bloody 
Urine. — Diabetes. — Irritability of the Bladder. — Inflam- 
mation of the Bladder. — Paralysis of the Bladder. . 151-159 



VU1 CONTEXTS. 

CHAPTER XI. 

ON SOME DISEASES OF THE SKIN AND HAIR. 

Erysipelas. — Rose Rash. — Nettle Rash. — Tetter. — Shin- 
gles. — Eczema. — Pemphigus. — Rupia. —Ecthyma. — Im- 
petigo. — Scald Head. — Itch. — Lichen. — Itching. — Scaly 
Leprosy. — Salt Rheum. — Dandruff. — Acne. — Lupus. — 
Barber's Itch. — Sycosis. — Elephant Leg. — Barbadoes Leg. 

— Diseases of the Hair. — Blanching of the Hair. — Bald- 
ness. — Gray Hair 1G0-177 

CHAPTER XII. 

DISEASES OF WOMEN, &c. 

Itching of the Vulva. — Leucorrhrra. — Whites. — Inflamma- 
tion of the Uterus. — Tumors. — Polypus. — Cancer. — Dis 
placements of the Uterus. — Falling of the Uterus. -Ante- 
version of the Uterus. — Retroversion of the Uterus. — Men- 
struation. — Menstrual Diseases. — Pregnancy. — Miscar- 
riage. — Abortion. — Milk Leg 178-198 

CHAPTER XIII. 

MANAGEMENT AND DISEASES OF INFANCY AND 
CHILDHOOD. 

Food of Infants. — Weaning. — Cleanliness and Clothing. — 
Exercise and Sleep. — Teething. — Eruption of Permanment 
Teeth. — Disorders of the First Dentition. — Disorders of 
the Second Dentition. — Convulsions. — Cholera Infantum. 

— Infantile Fever. — Incontinence of Urine. . . . 199-221 



CONTENTS. IX 

CHAPTER XIV. 

ON SUSPENDED ANIMATION, POISONING, &c. 

Suspended Animation from Drowning, Hanging, Impure 
Air, and Cold. — Boat Accidents. — Clothes catching 
Fire. — Sea Sickness. 

Poisoning — from Opium, Laudanum, Morphine, Arsenic, 
Alcoholic Liquors, Alkalies, Mineral Acids, Oxalic Acid, 
Prussic Acid, Strychnia, Corrosive Sublimate, and Lead. 

Trichina Spiralis. — Diseased and Decaying Food.— 
Caution to Persons overtaken by a Thunder 
Storm 222-232 



PART II. 

PRACTICE OF SURGERY. 

CHAPTER I. 

ACCIDENTS, WOUNDS, SURGICAL INJURIES, &c. 

Prostration. — Collapse. — Shock. — Methods of arresting 
Hemorrhage, or Bleeding. — Inflammation. — Mortification. 

— Gangrene. — Wounds. — Wounds of Particular Parts. — 
Poisoned Wounds. — Stings of Bees, &c. — Bites of Mos- 
quitos. — Fractures. — Dislocations. — Sprains. — Bruises. 

— Burns and Scalds. — Concussion of the Brain. — Com- 
pression of the Brain. — Bleeding from the Nose. — Com- 
pound Accidents. — Amputation. — Ruptures. . . . 233-260 



CONTENTS. 



CHAPTER II. 

' REMOVAL OFJ FOREIGN BODIES, BLOOD-LETTING,' &c. 

Removal of Foreign Bodies from the Throat, Nose, Ears, and 
Eyes. — Blood-letting. — Leeching. — Cupping. — Direc- 
tions for Passing Catheters, Bougies, and Sounds. . . 261-269 

CHAPTER III. 

ON SOME DISEASES OF THE EYE AND EAR. 

Near Sight. — Long Sight. — Weakness of Vision. — Inflam- 
mation of the Eye. — Stye. — Dimness of Sight. — Cataract. 
— Squinting. — Earache. — Inflammation of the Ear. — 
Discharge from the Ear 270-276 

CHAPTER IV. 

THE VENEREAL DISEASES, &c. 

Gonorrhoea. — Balanitis. — Gonorrhoeal Inflammation of the 
Eyes. — Gonorrhoeal Rheumatism. — Gleet. — Gonorrhoea 
in the Female. — Syphilis. — Primary Syphilis. — Affec- 
tions that may be Mistaken for Syphilis. — Treatment of 
Primary Syphilis. — Bubo. — Venereal Warts. — Secondary 
Syphilis. — Syphilitic Sore Throat. — Tertiary Syphilis. — 
Syphilitic Disease of Bone. — Treatment of Secondary and 
Tertiary Syphilis. — Syphilitic Disease in Children. — Other 
Diseases of the Urino-Genital Organs. — Stricture of the 
Urethra. — Swelled or Inflamed Testicle. — Dropsy of the 
Scrotum. — Varicocele. — Spermatorrhoea. — Impotency. — 



CONTENTS. * XI 

Diseases of the Prostate Gland. — Prostatorrhoea. — Inflam- 
mation of the Prostate Gland. — Enlargement of the Pros- 
tate. — Gravel and Stone. — Phymosis and Paraphimo- 
sis 277-307 



CHAPTER V. 

ON ABSCESS AND ULCERS. 

Abscess. — Ulcers. — Healthy Ulcer. — Inflamed Ulcer. — 
Fungous Ulcer. — Sloughing Ulcer. Indolent Ulcer. 
Varicose Ulcer. — Carious Ulcer. 308-312 



CHAPTER VI. 

DISEASES OF THE BONES. 

Caries. — Necrosis. — Brittleness of Bones. — Softening of 
Bones. — Rickets. — Disease of the Hip Joint. . . . 313-315 



CHAPTER VII. 

MISCELLANEOUS SURGICAL DISEASES. 

Tumors. — Aneurism. — Polypus. — Cancer. — Piles. — Fis- 
sure of the Anus. — Fistula in Ano. — Boils. — Carbuncle. 

— Chilblains. — Frost Bite. — Felon. — Whitlow. — "Wen. 

— Warts. — Corns. — Bunion. — In-growing Toe Nail. — 
Care of the Feet. — Rules for the Preservation of the 
Teeth 316-328 



PART III. 



CHAPTER I. 



Recipes. — Prescriptions. — Medicines. — Preparations for the 
Hair. — Colognes. — Tooth Powders. — Medicine Chest. 329-3G2 



CHAPTER II. 

Dietetic Preparations and Beverages for the Sick. . . 363-374 



PART I. 
PRACTICE OE MEDICINE. 



CHAPTER I. 
ON THE PRESERVATION OF HEALTH. 

Cleanliness and Clothing, 

In order to keep the body in a state of health, frequent 
bathing is requisite. In winter, once or twice a week will 
be sufficient ; but in summer, when the body perspires much, 
it should be clone • oftener. A bowl of cool water, a little 
soap, a sponge, and coarse towel, are all the essentials for 
keeping the body in a cleanly condition, if they are properly 
used. 

Under Garments should be changed at least once or twice 
a week in winter, and oftener in summer. All our clothing 
should be adapted to the climate, season of the year, and 
state of the weather. 

JPure Air. 

Pure air is essential to health, and all should see that 
the apartments in which they do business during the day, 
and in which they sleep, are well ventilated. 

Food, Drink, Digestion, &c. 

If you would keep your body in good condition, be tem- 

(i) 



2 MEDICAL AND SURGICAL COMPANION. 

perate both in eating and drinking. Only three meals a day 
should be taken, and the last at least three hours before 
retiring. The diet should consist of a proper admixture of 
animal and vegetable food, and its thorough mastication is 
essential. 

Tea and Coffee may be taken in moderate quantities, if 
they do not disagree with you. 

Alcoholic Liquors, taken daily, in health, are injurious to 
the system, and the less used the better. The same may be 
said of tobacco. Opium should never be used, except when 
prescribed by a physician. 

Time required for Digestion. 

The time required for digesting food, and for emptying 
the stomach of its contents, differs in different persons and 
circumstances. One kind of food is more easily dissolved 
than another ; and some persons can digest any definite kind 
of food more readily than others ; some are even oppressed 
by that which another digests with ease and comfort. 

There is also a difference in regard to the digestive power 
in the same person in different states of health. 

Dr. Beaumont's Observations. 

A young soldier, Alexis St. Martin, had a hole through 
his side and into his stomach, in consequence of a gun-shot 
wound. Through this aperture the whole process and prog- 
ress of digestion could be observed. Dr. Beaumont availed 
himself of this opportunity to learn the time required to 
digest various kinds of food, and to empty the stomach of 
its contents. 

The following table, which is taken from a larger table in 
Dr. Beaumont's work, shows the time required by St. Mar- 
tin for the digestion of the most common articles of diet. 
As the digestive power differs in different persons, this 
table must be received only as an approximation of the 



HINTS ON THE PRESERVATION OP HEALTH. 



average periods required for the digestion of these ar- 
ticles. 



Apples, sour, hard, . 
Apples, sweet, do. . . 

Beans, pod, 

Beef, fresh, lean, rare, 

Beefsteak, 

Beef, salted,old, hard, 
Beets, ... • . . . . 
Bread, wheat, fresh, . 

Bread, corn, 

Cabbage, with vine- 
gar, 

Cabbage, 

Cake, sponge, .... 
Cheese, old, strong, . 
Chicken, full grown, . 
Codfish, cured, dry, . 
Corn,green,and beans, 

Custard, 

Dumpling, apple, . . 
Eggs, fresh, 





Time. 


Preparation. 


m 


a 




= 


~. 


Raw, 


?, 


50 


Raw, 


1 


■>,() 


Boiled, 


9, 


:-!<> 


Roasted, 


a 




Broiled, 


3 




Boiled, 


4 


IS 


Boiled, 


3 


45 


Baked, 


3 


30 


Baked, 


3 


15 


Raw, 


9 




Boiled, 


4 


30 


Baked, 




30 


Raw, 


3 


:-;u 


Fricass'd, 


" 


45 


Boiled, 


?! 




Boiled, 


3 


45 


Baked, 


« 


45 


Boiled, 


3 




|Boiled, 


3 





Eggs, fresh, 

Fowl, domestic, . . 

Lamb, fresh, 

Liver, beers, fresh, . 

Meat, hashed with ve- 
getables, 

Milk, 

Mutton, fresh, . . . . 

Pork, fat and lean, . . 

Pork Steak, 

Potatoes, Irish, . . . 

Potatoes, Irish, . . . 

Rice, 

Sausage, fresh, . . . 

Soup, beef, vegeta- 
bles and bread, . . 

Tripe, soused, . . . . 

Turkey, domestic, . . 

Turnips, flat, . . . . 

Veal, fresh, 



Fried, 
Boiled, 
Broiled, 
Broiled, 

Warmed, 

Raw, 

Roasted, 

Roasted, 

Broiled, 

Broiled, 

Roasted, 

Boiled, 

Broiled, 

Boiled, 

Boiled, 

Roasted, 

Boiled, 

Fried, 



All persons should observe carefully the effects of various 
articles of food, as well as physic, upon their bodies, and 
choose those which experience proves to agree best with 
them. It is a vulgar, but sometimes true saying, that 
" what is one man's meat is another's poison." 

Severe exertion of body or mind, immediately after a full 
meal, should be avoided. No man should put himself to 
the severe exertion of mowing grass, pitching hay, planing 
boards, or severe exercise of the muscular system of any 
kind, for about an hour after eating ; and especially after 
dinner, Avhich is* generally the largest meal. 

Labor. 

A proper amount of labor, both physical and mental, is 
necessary to keep body and mind in a state of health ; but 
excessive labor must be avoided. No one should exceed ten 

hours a day. 

Rest. 

A sufficient amount of rest or sleep is required, every 
twenty-four hours, to restore or refresh the nervous system. 



4 MEDICAL AND SURGICAL COMPANION. 

The amount required varies, in different individuals, from 
seven to nine hours. It is well to have some regular time 
for retiring and rising. Children and youth who are grow- 
ing, require, as a general rule, more sleep than adults. 

Recreation and Amusements. 

All persons require periods of relaxation and rest from 
the toils and cares of business, whatever it may be ; and at 
such times, hunting and fishing excursions, picnics, sleigh 
rides, and plays and games which have no evil tendency, 
may be made profitable to health. 

These occasional amusements are recommended, not for 
the mere pleasure they are adapted to give, but also for 
the purpose of recreating and preserving a healthy and 
vigorous state of the body and mind, which cannot always 
be done without these aids. Those persons especially who 
are devoted to constant mental labor, must have resort to 
some kind of mental relaxation, or their constitutions will 
suffer loss : the mind cannot bear to be kept constantly on 
the stretch of exertion ; it will soon lose its elasticity and 
power, and the body give way. 



HINTS TO TRAVELLERS IN HEALTH. 
Flannel. 

The sudden changes of the weather, which so particularly 
characterize the climate of the United States, render a 
supply of flannel, to be worn next the skin, a matter of 
much consequence to the health and comfort of the traveller, 
who is more exposed than others to the morning and evening 
damps, as well as the meridian heat. 

As a general preservative of health, there is no habit more 
valuable than this. The garments for summer wear may 
be lighter than those for winter, but travellers should never 
leave off flannel entirely during any season of the year. 



HINTS TO TRAVELLERS IK HEALTH. O 

Beds. 

Travellers should examine closely the beds in which they 
are to sleep, and should be satisfied that they are clean ; for 
by sleeping in dirty ones, many troublesome and disgusting 
diseases of the skin may be contracted. It is better to 
sleep on the floor, with only your overcoat around you, than 
to sleep in a filthy bed. 

Water. 

Change of water is" apt to produce some little disturbance 
of the bowels ; and when this is the case, a little spirit, or 
essence of peppermint mixed with it, may prove beneficial. 

Cold. 

To prevent as much as possible any danger from frost, 
while travelling in excessively cold weather, having well 
cased your whole body (and feet in particular) in warm 
clothing, avoid approaching the fire, and the use of spirits 
or hot drinks of every description. When you stop on the 
road, instead of seating yourself by the fire and calling for 
liquor, walk about in the open air as rapidly as possible ; 
and if you are thirsty, take a glass of cold water or milk, and 
partake of as much substantial food as the system requires, 
three times a day. 

Three men once set out from Boston for Canada East, 
during the middle of a very severe winter, each one in his 
own sleigh. Two of them were in the habit of stopping at 
every hotel they came to, and drinking freely of liquor ; the 
other never entered a house, except for his meals or to 
sleep. While his horse rested he stretched his limbs, and 
when he was thirsty he partook of the same element with 
his beast. The consequence of this was, that out of the 
three, he was the only one who arrived at his journey's end 
uninjured. One of his companions had his feet so badly 
frozen, that he lost them both, and the other was taken out 



6 MEDICAL AND SURGICAL COMPANION. 

of his sleigh at the door of a hotel, where his horse nat- 
urally stopped, frozen to death. 

If, notwithstanding all your care, you become much 
affected with the cold, beivare of going to sleep. No matter 
how strong the inclination may be, resist it for your life ; it 
is the sleep of death I 

ICp 3 Never let false delicacy, or any other cause, prevent 
you from emptying the bladder as often as you feel the in- 
clination ; a painful and lingering, sometimes an incurable 
disease arises from neglecting this call of nature. 

The bowels should move at least once in twenty-four 
hours ; and the habit of attending to this demand of nature 
at some particular time in the day, as after breakfast or 
supper, will do much towards keeping them in good con- 
dition. 



HINTS TO INVALIDS TRAVELLING. 

Although the preceding advice or directions apply to all 
travellers, sick or well, they should be more particularly 
studied and observed by invalids, who, while travelling by 
laud, either for the restoration of their health, or from 
necessity, will find it well to observe the following rules : — 

Rule 1. 

Never commence your journey in the morning until you 
have breakfasted and emptied the bowels, or endeavored to 
do so. To obtain the wished-for result, make it a regular 
practice to solicit the evacuation directly after your meal. 

Rule 2. 
During the summer never pursue your journey, if you can 
avoid it, in the heat of the day. It is better to borrow an 
hour or two from the morning, and one from the evening, 
than to risk the excitement liable to be produced by a broil- 
ing sun. 



HINTS TO INVALIDS TRAVELLING. V 

Eule 3. 
Make short stages, always remembering that exercise 
should never be pushed to fatigue ; the latter is as injurious 
as the former is beneficial. 

Rule 4. 

Always carry a piece of good rhubarb in your pocket, 
and, if costive, chew a portion of it during the day, and 
swallow the saliva. 

Laudanum and essence of peppermint it is always well 
to have at command. 

Eule 5. 

Be careful to have no ligatures about your body. Cravat 
and " elastics " should be loosely fastened, and let all your 
clothing be easy. The flannel shirt is indispensable. 

Eule 6. 

Always carry with you an ample overcoat or cloak ; early 
in the morning and in the evening, even of summer days, 
you may find occasion to use it with pleasure and profit. 

Always have a complete suit of winter clothing in your 
trunks, although you be travelling in the month of July. 
If the weather becomes cool, on with your woollens, stock- 
ings included. Inattention to the simple rule of adapting 
the clothing to the temperature of the air in its extreme 
changes kills thousands yearly. 

Eule 7. 
Never hesitate a moment to comply with the calls of 
Nature : much mischief is occasioned by deferring these 
evacuations. It is better to be accused of a want of deli- 
cacy than to have a suppression of urine, or a fever and 
headache. 

Eule 8. 
This is a " golden rule," and is of high authority : — 
Keep your body open, your feet dry and warm, and your 
head cool. 



MEDICAL AND SURGICAL COMPANION. 



MEDICINES. 

Persons travelling by land or sea, and whether sick or 
well, should have a few medicines with them to use in cases 
of sudden attacks of illness. 

A few well-selected and well-understood medicines will be 
far better than a large number, the uses of which are not 
well understood by those having them. 

I will mention only a few which will be found most 
useful. 

Laudanum. (Tincture of Opium.) 

This may be used to relieve pain and promote sleep. The 
ordinary dose for an adult is twenty-five drops. It should 
not, as a general rule, be repeated oftener than once in three 
to six hours, and not then unless really required. In cases 
where there is severe pain, thirty to forty drops may be re- 
quired to give relief. 

A youth of fourteen years will require about half as 
much as an adult ; a child of four years, three to five or 
six drops. 

Paregoric. (Camphorated Tincture of Opium.) 

This preparation is used for the same purposes as Lauda- 
num, but is better adapted to young children. 

A child three to six months may take . 3 to 5 drops. 

" from six months to one year, . 5 to 10 drops. 

" from one to two years, . . 10 to 15 drops. 

" from two to four years, . . 15 to 30 drops. 

These preparations should only be used when absolutely 
required to relieve pain or promote sleep. 



MEDICINES. y 

Essence of Peppermint. 

Useful in cases of wind in the bowels (flatulency), and as 
a stimulant in cases of faintness. 

Dose for an adult, one teaspoonful ; children in proportion 
to age. A little laudanum or paregoric may sometimes be 
added to advantage. 

It may be given in a little warm water, sweetened or not, 
according to preference. It may be repeated as occasion 
requires. 

Powdered Ipecac. 

This is an emetic, and may be used to throw off indigesti- 
ble food, and may sometimes be of advantage in the early 
stage of fever. 

Dose for an adult, .... 20 grains. 

" for a youth of fourteen years, . 15 grains. 

" for a child of three to six years, . 3 to 8 grains. 

It may be mixed with molasses, or sugar and water. 
After waiting a few minutes, drink freely of warm water, or 
some warm bitter herb tea, until free vomiting takes place. 

Wine of Ipecac. 

This may be used for the same purpose as the above, also 
in teaspoonful doses as an expectorant in bronchitis. 

Dose for an adult, as aD emetic, one ounce. For children, 
one to two teaspoonfuls may be given, and repeated every 
ten or fifteen minutes, until vomiting takes place. Warm 
water may be freely taken until it operates. 

Compound Cathartic Pills. 

An excellent purgative. Dose for an adult, two to three.. 

Castor Oil. 

Dose for an adult, as a purgative, one ounce. For chil- 
dren, one teaspoonful to a tablespoonful. This is a mild 



10 MEDICAL AND SURGICAL COMPANION. 

and excellent purgative, and may be used in cases where 
more powerful cathartics would be objectionable. 

Tincture of Mliubarb. 

An excellent and common purgative. Dose, from an 
ounce to an ounce and a half. 

Adhesive Plaster. 

This is often of use, and no family or traveller should be 
without a good supply for dressiug cuts, wounds, &c. 

Simple Ointment. 

Useful in dressing burns, scalds, sores, and wounds. 

Glycerine. 
Excellent for chapped hands, excoriations, &c. 

Anodyne Liniment. 

Take of 

Laudanum, .....£ ounce. 
Tincture of arnica, .... 1^- ounce. 
Mix, and mark Liniment. 
An excellent preparation for sprains, bruises, &c. 

Brandy. 
A little brandy is never out of place in a traveller's trunk, 
providing he will only use it when necessary as a medicine 
to relieve sudden faintness or great prostration from accident 
or sickness. 

The amount taken at a time should not, as a general rule, 
exceed one to two tablespoonfuls. 



MEASURES. 



Apothecary's Weights and Measures. 

The weights accompanying apothecary's scales are thus 
marked : — 



WEIGHTS AND MEASURES. 



11 



. equal 


to 8 drachms 


a 


4 


a 


a 


120 


grains. 


cc 


60 


" 


a 


30 


a 


c; 


20 


a 


u 


10 


a 



§j for one ounce, 
§ ss " half an ounce, . 
3ij " two drachms, . 
3j " one drachm, . 
3 68 " half a drachm, 
9j " one scruple, 
9ss " half a scruple, 
The thin grain weights are marked, exclusive of the 
stamp, with a peculiar round mark or dot for each grain. 

Fluid or Wine Measure. 
The graduated glass measures used by apothecaries in 
measuring fluids are marked with the § (ounce) and 3 
(drachm) signs. 

The pint or pound contains 16 ounces. 
The ounce " 8 drachms. 

The drachms " 60 to 120 drops 



Domestic Measure. 

A small teacup is considered 

equal to 
A wineglass, 
A tablespoon, 
A teaspoon, 



4 fluid ounces, or 1 gill. 

2 

1 fluid drachm. 



The Doses of Medicine adapted to Different Ages. 

For an adult, suppose the dose to be one, or 1 drm., equal to 60 grs. 
Patients of 1 year will require only ^ or 5 grains. 



" 2 years " " 


" i,or7i « 


" 3 " " 


" 1 , or 10 » 


" 4 " " 


«« i , or 15 « . 


" 7 " " 


" \ , or 20 " 


" 14 " " 


" \ ' or \ drachm 


« 20 " " " 


" |, or 2 scruples 


21 " « 


" one, or 1 dr., the 



Above 

Persons above sixty-five years require the dose to be 
diminished as they grow older. 



12 MEDICAL AND SURGICAL COMPANION. 

Women, as a general rule, require only about three fourths 
as much as men. 

In the same manner for fluids, divide the quantity suited 
for an adult by the above fractional parts. 

Opiates affect children more powerfully than adults, and 
must be used with caution. 

Habit has an important influence on the operation of med- 
icines. In general, habit diminishes the effect resulting from 
the action of external powers on the system ; hence med- 
icines lose power by being continued. This is particularly 
the case with stimulants and narcotics, and the doses of 
them, therefore, require to be increased when their use is 
protracted. 

When doses have been mentioned in this work, they have 
been for adults, unless otherwise stated. 



BLOOD-VESSELS. 

There are two kinds of blood-vessels in the body — arte- 
ries and veins. The arteries carry the blood from the heart 
to the extremities of the body, where they are connected 
with the veins, which bring it back again. 

The Pulse. 

The pulse is the beating of an artery, which is a vessel 
conveying blood from the heart. Every time the heart con- 
tracts, a portion of blood is forced into the arteries, which 
dilate or swell to let it pass, and then immediately regain 
their former size, until, by another beat of the heart, a fresh 
column of blood is pushed through them, when a similar 
action is repeated. This swelling and contracting of the 
arteries, then, constitute the pulse, and consequently it may 
be found in every part of the body where those vessels run 
near enough to the surface to be felt ; but, from motives of 
convenience, physicians usually look for it at the wrist. 



THE PULSE. 13 

The strength and velocity of the pulse vary much in dif- 
ferent persons, even in a state of perfect health. It is much 
quicker in children than in adults, and in old persons it 
grows more slow and feeble, owing to the decreased energy 
of the heart. 

In children under four years of age it generally exceeds 
one hundred beats per minute. In the adult male it may 
be stated at about seventy, and in the adult female at about 
eighty. 

The pulse is increased both in strength and velocity by 
running, walking, jumping, and riding ; also by eating, 
drinking, singing, speaking, and by joy, anger, &c. It is 
diminished in like manner by rest, fear, melancholy, want of 
nourishment, excessive evacuations, or whatever tends to 
debilitate the system. The temporary excitement often 
caused by the approach of the physician to the bedside 
causes increased rapidity of the pulse, for which due allow- 
ance should be made, or, what is better, we should wait a 
few minutes, until the excitement has ceased. 

A full, tense, and strong pulse is when the artery swells 
boldly under the finger, and resists its pressure more or less ; 
if, in addition to this, the pulsation be very rapid, it is called 
quick, full, and strong ; if slow, the contrary. 

A hard, corded pulse is that in which the artery feels like 
the string of a violin, or a tightened cord, giving consider- 
able resistance to the pressure of the finger. 

The soft and intermitting pulses are readily recognized by 
their names. In cases of extreme debility, on the approach 
of death, and in some particular diseases, the artery vi- 
brates under the finger, like a thread. In feeling the pulse, 
two or three fingers should be laid on at once. As already 
mentioned, the most convenient spot to do this is at the 
wrist; but it can be done readily on the temple — just be- 
fore and close to the ear, in the bend of the arm, and on 
the top of the foot. 



14 MEDICAL AND SURGICAL COMPANION. 



GENERAL RULES TO BE OBSERVED IN THE TREAT- 
MENT OF DISEASES. 

Rule 1. 

In every complaint, whatever it may be called, if you find 
the pulse quick, hard, full, and strong, tongue foul, skin 
hot, pain in head, the proper course is to keep the patieut 
quiet, and on a low diet, with cold water or lemonade for 
drink. A smart purgative may also be administered. 

Rule 2. 

If, on the contrary, the pulse be small, soft, feeble, and 
intermitting, the tongue dark, and great debility or weak- 
ness is evident, reverse the whole plan ; the diet must con- 
sist of milk, strong beef-tea, or essence of beef, the bowels 
opened with gentle laxatives, — such as a small dose of cas- 
tor oil, or a Rochelle powder, — and the strength supported 
by wine, brandy, quinine, &c. 

Rule 3. 

Incessant and earnest entreaties, on the part of the sick, 
for any particular article of diet or drink, if steadily perse- 
vered in, may be indulged to a proper extent, whether the 
use of it agrees or not with our preconceived ideas on the 
subject. 

Rule 4. 

In all fevers, where the pulse is quick, full, and strong, 
the skin hot and dry, sponging the whole body of the patient, 
once or twice a day, with warm water, will prove beneficial. 
The patient should always be wiped dry. The addition of a 
tittle bicarbonate of soda to the water, every second day, is 
Advisable. A tablespoonful to a pint will be sufficient. 



GENERAL RULES. 15 

Eule 5. 

The SicJc Hoom. 

The sick room should be of good size, away from noise, 
and from the odors of the kitchen. It should be kept clean, 
of proper temperature, and well ventilated. A plenty of 
fresh air is an important remedial agent in all diseases. 
The excretions of the patient should be removed as soon as 
passed, and his clothing and the bedding require frequent 
changing. 

Eule 6. 
The Nurse. 

If a nurse is employed, be sure that she is a woman of 
good sense, good disposition, temperate, kind, attentive to 
her duties to the patient, and one who will carry out the in- 
structions of your physician. 

A nurse who is continually neglecting the physician's 
orders, or questioning his judgment in regard to the man- 
agement of the case, and perhaps trying to get the patient 
placed under the care of another physician, for whom she 
has a predilection, is unworthy of confidence or trust, and 
the sooner discharged the better for all concerned. 



16 MEDICAL AND SURGICAL COMPANION. 



CHAPTER II. 

FEVERS. 

OF FEVER IN GENERAL. 

In a work of this kind, I believe it is a matter of little 
consequence with what particular complaint we begin, since 
each one is to be described ; therefore I will commence 
with fever, which arises from the contamination of the blood 
by some morbific agent, and is by far the most common 
disease to which the human body is subject. It is indicated 
by a hot, dry skin, rapid pulse, thirst, loss of appetite, weak- 
ness, and inability to sleep. It makes its appearance in 
two ways, — either suddenly and violently, or gradually and 
gently. When it comes on in the first manner, it is attend- 
ed with chills, or a cold shaking, nausea or vomiting, pain 
in the head, &c. When its attack is gradual, a feeling of 
soreness over the whole body — such as is experienced after 
a hard day's work, by one not accustomed to it — indicates 
its approach. Nausea, pains in the head, and more or less 
heat and thirst, soon follow. As those symptoms vary infi- 
nitely in their degrees and violence, the vigor of treatment 
to be pursued must differ accordingly. 

Fever produces a general disturbance, visible throughout 
the whole system. 

I will now proceed to consider the different varieties of 
fever, and will take them up in the following order : — 

1. Simple Inflammatory Fever. 

2. Intermittent, or Fever and Ague. 

3. Remittent Fever. 

4. Yellow Fever. 

5. Typhoid Fever. 

6. Typhus Fever. 



SIMPLE INFLAMMATORY FEVER. 17 

7. Hectic Fever. 

8. Eruptive Fevers, — Small Pox, Chicken Pox, Measles, 
and Scarlet Fever. 

Continued fever is so termed from the fact that it pursues 
its course without any well-marked remissions. 

Simple inflammatory fever, typhoid fever, and typhus 
fever, are called continued fevers. 



SIMPLE INFLAMMATORY FEVER (Febricula). 

Simple Inflammatory Fever usually makes its invasion 
abruptly, and the patient will generally have some irregular 
chilly sensations, a rapid pulse, hot skin, thirst, loss of appe- 
tite, headache, constipation, scanty and high-colored urine, 
&c. The febrile career usually ends suddenly, after one, 
two, or three days, the limit of the duration being ten days. 

Causes. Among the causes may be mentioned expo- 
sure to cold, violent exercise, exposure to the sun's rays, 
intemperance, the indulgence of unruly passions, &c. 

Distinguish it from typhoid fever by the strength and 
hardness of the pulse, white tongue, and high-colored urine. 

Treatment. Rest in bed, open the bowels with a 
dose of Epsom salts, and if the skin be very hot, and 
there is much thirst, give a teaspoonful of R. 21 in a wine- 
glass of water every fourth hour. Half a teaspoonful of 
sweet spirit of nitre will answer very well, if you do not 
have this mixture at hand. In some cases, where the fever 
runs very high, the dose may be repeated every second or 
third hour. Soaking the feet in hot water, and applying 
cloths wet with cold water, or spirit and water, to the head, 
will prove beneficial in all cases, especially if there is much 
headache. 

For nourishment, the patient may take oatmeal or Indian 
meal gruel, and milk. For drink he may take cold water 
or lemonade. 

2 



18 MEDICAL AND SURGICAL COMPANION. 

The apartments in which fever patients are sick should be 
kept quiet, clean, well ventilated, and a little darkened ; 
and every source of excitement should be avoided. 



INTERMITTENT, OR FEVER AND AGUE. 

There are several varieties of this fever, differing from 
each other only in the length of time that elapses between 
their attacks. When a paroxysm occurs every twenty-four 
hours, it is called quotidian ; when every forty-eight hours, 
it is designated tertian ; aud when the interval lasts seventy- 
two hours, it is termed quartan. 

Symptoms. The disease commences with yawning, 
stretching, and uneasiness, succeeded by slight chills or 
shiverings, which end in a violent convulsive shaking of the 
whole body. This is called the cold fit or stage, aud is im- 
mediately followed by the fever, or hot stage. The pulse 
then rises, the skin becomes hot, there is paiu in the head, 
a white tougue, and all the marks of fever, terminating in a 
profuse sweat, which gradually subsides, leaving the patient 
in his natural state, though somewhat weakened. 

Causes. Marsh miasmata, or the effluvia from vegeta- 
ble matter, in a state of decomposition ; also, the effluvia 
arising from certain soils impregnated with moisture, but 
apparently free from vegetable decomposition. 

Treatment. If the bowels are constipated, give two or 
three compound cathartic pills, and then commence giving 
R. 14G, in teaspoonful doses, every hour, the first dose to be 
given six hours before the expected paroxysm, or chill. 
When the medicine begins to cause ringing in the ears, it 
may be omitted for a time. If another paroxysm occurs it 
may be resumed. The medicine is not to be given during 
the paroxysms, but between them. After the paroxysms have 
been interrupted, the remedy should be taken, three or four 
times a day, for a considerable period. 



REMITTENT FEVER. 19 

During the cold stage of this fever warm drinks may be 
administered, and warm bricks or bottles of hot water placed 
to the feet and sides. 

During the hot stage, relief may be procured by sponging 
the body with cold or tepid water, and partaking of cooling 
drinks, lemonade, &c. 

During the sweating stage, comfort is promoted by wiping 
the body with warm flannel, and changing the linen and 
bed-clothes, taking due care to aroid exposure to cold. 



REMITTENT FEVER. 

This disease is known under different names, as Gastric 
Fever, Bilious Fever, and Bilious Remittent Fever. It is 
accompanied by distinct exacerbations of variable duration 
and severity, but without any complete intermission, such 
as we have in intermittent fever. 

Symptoms. There is tenderness of the epigastrium, or 
pit of the stomach, and some irritation of that organ ; and 
yellowness of the skin, and bilious vomiting, are generally 
present in a greater or less degree. 

Diarrhcea is sometimes present, while in other cases the 
bowels are obstinately constipated. The tongue is either 
remarkably clear, or covered with a thin fur, or redder than 
natural at the tip and edges. 

The pulse ranges from ninety to one hundred and twenty. 
Head symptoms are not very common, but when they do 
occur, the patient is not often delirious, but melancholy. 

In the Remittent Fever of hot climates, the symptoms of 
gastric irritation and bilious disorder are more strongly 
marked, and violent delirium, with intense thirst and great 
heat of skiu, often shows itself at an early period. 

The duration of this fever is from one to four or five 
weeks. It may be distinguished from the intermittent, or 
fever and ague, by the incomplete intermission ; from contin- 



20 MEDICAL AND SURGICAL COMPANION. 

ued fever, by the occurrence of intervals of comparative 
freedom from fever. 

Treatment. If the bowels are constipated, give a ca- 
thartic composed of eight grains of calomel and twelve of 
jalap. If there is great heat of skin, the surface of the 
body may be bathed once or twice a day with cool or mod- 
erately warm water, into which may be put a little bicarbo- 
nate of soda. 

Cold water, toast water, barley water, or lemonade, may 
be drank to allay thirst. Should there be much tender- 
ness at the pit of the stomach, with some vomiting, a mus- 
tard poultice placed over that region will generally prove 
beneficial. It should be kept on as long as it can be con- 
veniently borne, and when removed, hot fomentations may 
be substituted. When the headache is severe, cold water 
may be freely applied to it, aud warmth to the feet. 

When the fever ruus high, a teaspoonful of R. 21 may 
be taken in water three or four times a day. If this 
mixture is not at hand, half a teaspoonful of sweet spirit 
of nitre three or four times a day may be substituted. If 
the patient does not rest well, ten grains of Dover's powder 
may be given at night to promote sleep. 

Duriug the remissions, or when the patient is comparative- 
ly free from fever, give a teaspoonful of R. 146, every hour, 
as in fever and ague, until slight ringing in the ears is expe- 
rienced, when it may be omitted. If another paroxysm 
occurs, it may be resumed. After the paroxysms have been 
interrupted, the remedy may be taken three times a day for 
a week or two. It should never be given during a parox- 
ysm of fever. For diet ; gruel, milk, &c. 

YELLOW FEVER. 

Yellow fever is a disease of warm climates, and depends 
upon a special cause. It occurs mostly during the summer 
months, and ceases on the appearance of frost. It occurs 



YELLOW FEVER. 21 

chiefly in towns along the seaboard, or upon streams which 
empty into the ocean. 

Symptoms, &c. The striking features of this fatal disease, 
in addition to the general fever, are the yelloAvness of the 
skin ; severe headache, referred to the forehead and bottom 
of the orbit ; mental and bodily prostration, and great irri- 
tability of the stomach, — the matter vomited being at first 
slimy and tasteless, but gradually assuming the appearance 
of coffee-grounds, when it is called the black vomit. The 
dejections generally have a tarry appearance. There is 
often suppression of urine. The usual duration of the disease 
is from three to seven days. When the sixth day elapses 
without the appearance of Hack vomit, or suppression of 
urine, there is great hope of recovery. Death, when the 
disease proves fatal, usually occurs from exhaustion. The 
special poison of yellow fever appears particularly to affect 
the liver. 

Treatment. The indications for treatment are not very 
prominent, but urgent symptoms should be treated as they 
present themselves. If the bowels are constipated, give five 
grains of calomel with fifteen of jalap, to move them. If 
the fever runs high, give half a teaspoonful of sweet spirit 
of nitre, in a little water, every third or fourth hour. If 
there is much headache, apply cold water to the head and 
warmth to the feet. If the stomach is very irritable, apply 
a mustard poultice, followed by hot fomentations, over that 
organ, and let the patient swallow, occasionally, small 
pieces of ice. 

If there is much prostration, half a teaspoonful of the 
tincture of the chloride of iron, in a wineglass of water, 
every second or third hour, will generally prove beneficial. 
In some cases of great prostration, stimulants do good. 

The apartment should be kept well ventilated, and all 
excrementitious matters promptly removed. 



MEDICAL AND SURGICAL COMPANION. 



TYPHOID FEVER. 

This is a slightly infectious and contagious fever, and, be- 
ing most prevalent in autumn, is known in some parts of this 
country as the autumnal or fall fever. Persons between the 
ages of twelve and thirty years are most subject to it. It 
attacks all classes, rich and poor alike. 

Cause. This is not definitely known ; but it is most 
prevalent where we find pools of stagnant water, bad drain- 
age, foul air, &c. 

Symptoms. This disease is generally very insidious in 
its approach. There is a sense of weariness, languor, and 
general uneasiness, slight headache on rising in the morning, 
dulness of intellect, irregular flashes of heat or chilliness, 
slight acceleration of the pulse, furred tongue, and a dis- 
position to diarrhoea. These symptoms may last from sev- 
eral days to a week or more, after which the disease is 
established by the occurrence of a chill, followed by the 
ordinary phenomena of fever. After the disease has be- 
come settled, the pulse rauges from ninety to one hundred 
and twenty, being generally higher in females than in males. 
As a general rule, the pulse is under one hundred per min- 
ute. There is pain in the limbs, back, and head, with a 
dull, heavy expression of the countenance, restlessness, 
bleeding from the nose, and yellow, watery diarrhoea. 

As the disease advances, these symptoms become aggra- 
vated, the pulse increases in frequency, the skin becomes 
hot and dry, the tongue is parched, and becomes red at 
the tip and edges. There is pain in the right iliac region, 
■with a gurgling sound upon pressure ; tympanitis is also 
present, and there also frequently appear, about this time, 
symptoms of either bronchitis or lung fever (pneumonia). 

About the seventh or ninth day, if the surface of the ab- 
domen be carefully examined, there will be discovered upon 
it a number of small, round, red spots, called " rose-spots," 



TYPHOID FEVER. 23 

which disappear temporarily upon pressure, and constitute 
a characteristic eruption. They are about one line in diam- 
eter, and are slightly elevated above the surface of the body. 
At the same time, or sometimes not until a week later, a 
crop of vesicles, called sudamince, may also be detected upon 
the neck and chest. The rose-colored spots are not met with 
in all cases. 

In severe cases, about the middle of the second week, 
all the symptoms become aggravated, delirium supervenes, 
with ringing or buzzing sounds in the ears, followed by dul- 
ness of hearing, or deafness ; the eyes are injected, the 
tongue becomes incrusted with a black coating, which often 
cracks and peels off, leaving the raw surface exposed, and 
the teeth are covered with sordes ; the pulse becomes more 
frequent and feeble, and there is a low, muttering delirium, 
and sometimes twitching or spasm of the muscles. As the 
patient becomes more feeble, he slips down to the foot of the 
bed : there are involuntaiy evacuations, with hemorrhage 
from the bowels or other mucous surfaces. 

If the disease is to terminate favorably, the symptoms 
abate, the countenance brightens, the tongue clears, the 
pulse lessens in frequency, and the evacuations become more 
healthy. If the tongue ceases to clear, and if it again be- 
comes dry, it indicates an increase of intestinal disease. 

There is scarcely an organ in the body which may not be, 
in this disease, the seat of some anatomical lesion ; those 
which are most characteristic, however, are found in the 
intestines, and consist in the thickening, softeniDg, and ulcer- 
ation of the glands of Peyer. 

Sometimes, in the course of the second or at the beginning 
of the third week, the patient is seized with intense pain in 
the abdomen, vomiting of green, bilious matters, a small, 
fluttering pulse, fainting, and coldness of the extremities. 
The cause of these symptoms is perforation of the intestine, 
and escape of its contents into the cavity of the abdomen, 
causing inflammation. It occurs most frequently in the 
mild forms of the disease, and is almost uniformly fatal. 



24 MEDICAL AND SURGICAL COMPANION. 

This disease may be distinguished from others by the 
slowness and insidiousness of the attack, by the diarrhoea, 
the dusky hue of the countenance, the bleeding from the 
nose, the rose-colored eruption, the gurgling in the right 
iliac fossa, the tympanitis, the stupor and delirium, the ap- 
pearance of the tongue, and, lastly, by the duration of the 
disease, and the peculiar musty smell when the skin is dry, 
and acid smell when it is moist. 

Not even the mildest cases of this disease can be looked 
upon as free from danger ; and, on the other hand, there is 
no condition so low, no symptom so fatal, that death should 
be considered inevitable. Among the most unfavorable 
symptoms are constant delirium, a belief on the part of 
the patient that nothing ails him, a sudden shifting of posi- 
tion on the elbows, deep coma, twitching and rigidity of the 
limbs, profuse diarrhoea, or bleeding from the bowels, &c. 

Treatment. Most physicians of the present day regard 
this as a self-limited disease, and do not believe it can be 
shortened by treatment. It usually runs its course in about 
three weeks, when convalescence begins. It is only slightly 
contagious, and some physicians do not believe it is at all 
so. It is not often that those who take care of "typhoid 
fever patients contract the disease, when they take proper 
care of themselves, are not too much deprived of rest, and 
keep the sick room well ventilated, and see that the patient's 
excreta are promptly removed. A little chloride of lime 
or chloride of soda, set in vessels about the room, is useful 
as a disiufectant. 

The sick room should be of good size, Avell ventilated, 
and away from noise. No more persons should be allowed 
in the room than are necessary to take care of the pa- 
tient. For nourishment, good milk may be freely drank. 
A cupful, or more, repeated every two hours, is better than 
a large quantity takeu at longer intervals. 

As drink to allay thirst, cold water, weak lemonade, or 
barley water, may be taken. 



TYPHOID FEVER. 25 

At the commencement of the disease, an emetic of ipecac 
may sometimes prove beneficial ; but cathartics are seldom 
advisable, as there is usually a tendency to diarrhoea, which 
needs to be repressed rather than encouraged. 

if the skin is hot and dry, half a teaspoonful of sweet 
spirit of nitre, or a teaspoonful of R. 21 may be given in 
a little water, two or three times a day, and the whole 
surface of the body may be sponged over once a day with 
R. 134, warm, after which it should be wiped dry. 

If severe pain in the head and delirium are present, cold 
water, iced water, or cold spirit and water, freely applied, 
will be very beneficial. 

If the patient is restless, and not inclined to sleep during 
the night, eight or ten grains of Dover's powder may be 
given. 

If you have diarrhoea, either with or without hemorrhage 
from the bowels, give a powder of R. 72 twice or three 
times a day, to keep it in check. 

Should the patient at any time become very much pros- 
trated, a little wine, or brandy and water, may be given 
three or four times a day, and beef tea, or essence of beef, 
wine whey, or milk punch, given as occasion requires. The 
quinine mixture, R. 146, may also be given in teaspoonful 
doses, three or four times a day. It may be given in water, 
or added to the spirit. 

During convalescence, greater care will be required than 
after other forms of fever ; since any irritation applied to 
the cicatrizing or healing ulcers in the intestine will possi- 
bly affect them unfavorably, and re-excite that morbid action 
which may end in perforation of the bowels, and, conse- 
quently, death. The return to the usual diet must be very 
gradual, no solid food being allowed until the tongue has 
become clean and moist, the pulse soft, and till all feverish 
excitement has vanished ; until which time, also, the patient 
should neither be allowed to leave his bed, nor even to sit up 
much in it. 



Zt> MEDICAL AND SURGICAL COMPANION. 

I have dwelt at some length in treating of this fever, be- 
cause it is a very common and serious disease. Always 
place the patient under the care of a regular physician, if 
one is to be obtained. 



TYPHUS FEVER. 

Under this head are usually classed camp, jail, and ship 
fever. It is eminently contagious and infectious ; it often 
prevails epidemically, attacking individuals of all ages ; and 
it is the accompaniment of destitution, being generated in 
over-crowded and ill-ventilated dwellings, ships, &c. Its 
duration is from fourteen to twenty-one days. 

Of the nature of the disease little is known. The prob- 
ability is, that a poison is absorbed, which at once depresses 
the powers of the nervous system, and vitiates the blood. 

Symptoms. Before the attack commences, the patient is 
often low-spirited and languid, loses his appetite, and he 
feels ill without knowing why. At the same time there may 
be sharp pains in the head, back, loins, aud lower extrem- 
ities. A chill or violent shivering is often the immediate 
precursor of the disease ; sometimes, however, the cold stage 
is so slight as scarcely to be noticed. When the fever is 
fairly established, it is generally well marked. The skin is 
hot and dry, and the heat is of a pungent, biting character. 
The pulse is full, frequent, and possessed of some degree of 
strength, but is easily compressed. The tongue is moist, 
and covered with a yellowish-white fur. Sometimes there 
is nausea and vomiting. The bowels are costive, and no 
stools are procured without medicine. The aspect of the 
patient is peculiar ; the countenance is of a dusky hue, with 
injection of the eyes ; the features are fixed and inexpres- 
sive, or expressive only of apathy and indifference. 

In severe cases, as the disease advances, the symptoms 
augment in violence, the heat of the skin increases, the 



TYPHUS FEVER. 27 

pulse rises in frequency and diminishes in force, ranging 
generally from one hundred and twenty to one hundred and 
fifty, or one hundred and sixty. The respiration is frequent, 
and sometimes imperfect at the back and lower part of the 
chest. At a period ranging from the fourth to the eighth 
day, a peculiar eruption appears upon the surface, not con- 
fined, however, to any particular locality. It varies in color 
from a dusky reddish-brown to purple or black. It is not 
elevated above the surface, neither does it disappear upon 
pressure. The tongue becomes dry, brown, and cracked, 
and, along with the gums, is covered with sordes ; the 
urine scanty and highly colored ; the discharges from the 
bowels, when procured, black and offensive ; a peculiar am- 
moniacal odor is exhaled from the body ; the nervous system 
becomes more prominent ; there is dizziness, confused vis- 
ion, ringing in the ears, and sometimes deep stupor, which 
becomes characteristically more profound as the disease 
advances. Sometimes violent delirium takes the place of 
stupor ; the patient is sleepless or restless, with the sensa- 
tion of utter prostration and helplessness. Should no im- 
provement take place, the disease passes on to the last stage 
— that of prostration. The patient lies insensible, or in a 
muttering delirium, with twitching of the tendons, hic- 
cough, involuntary evacuations, and extreme insensibility of 
the surface, till at length death approaches silently and 
without violence. 

Sometimes a critical discharge takes place from some 
organ, and the patient begins to improve ; generally, how- 
ever, by slow degrees, and under the influence of supporting 
treatment. 

The duration of the disease varies ; sometimes, in mild 
cases, terminating on the seventh day ; sometimes running 
out to six weeks, or more. When fatal, death rarely occurs 
before the second week. 

Treatment. A large, well-ventilated room, frequent 
changes of linen, daily bathing of the patient's body, re- 



28 WEDICAL AND SURGICAL COMPANION. 

moval of all unnecessary carpets and curtains, and the im- 
mediate removal of all evacuations, are measures essential, 
both to mitigate the patient's disease, and to prevent it from 
infecting his attendants. Chloride of lime, or liquid chloride 
of soda, may be sprinkled about the room every day or two. 

When this disease makes its appearance on shipboard, or 
in jail, or camp, free and thorough ventilation and cleansing 
should immediately be resorted to, and chloride of lime be 
sprinkled about in abundance. 

No violent efforts should be made to cut this disease short, 
but the symptoms should be watched, and relieved as they 
arise. In the early stages, and in the whole course of mild 
cases, it is particularly necessary to beware of doing too 
much — of interfering too actively with Nature. We are 
able to treat, but cannot cure, these maladies, any more than 
we can cure small pox or measles ; and therefore our aim 
must be to keep the patient alive until the fever poison has 
expended itself. 

When the patient is seen early, an emetic may prove 
advantageous, and one ounce of wine of ipecac, with plenty 
of warm water, may be given for that purpose. Imme- 
diately after the operation of the emetic, a purgative, to 
thoroughly clear the intestines, will generally be useful. 

The following drink generally proves serviceable in this 
disease : — 

Take of Diluted Hydrochloric Acid, 3 drachms. 

White Sugar, ... 1 ounce. 

Water, or Barley Water . 1 quart. i 

Mix. Use as a daily drink. 

As a change, plain water, barley water, lemonade, or toast 
water may be allowed. 

The diet should be restricted to milk, farinaceous food, 
and thin broth, well salted. Tea and coffee, when they do 
not disagree, are considered useful by some. 



TYPHUS FEVER. 29 

As soon as the powers of life begin to fail, and there is 
a signal loss of strength, a dark-brown tongue, and a rapid, 
feeble pulse, a stimulating plan of treatment should be com- 
menced. This consists in giving strong beef or chicken tea, 
with brandy and water. The brandy should be given in 
such quantities as the extent of prostration may demand. 
Two teaspoonfuls, or one tablespoonful, or two tablespoon- 
fuls may be administered in water or beef tea, every two 
hours, or every hour, the effect produced being closely 
watched, and its repetition guided by such effect, remember- 
ing that severe febrile symptoms do not contra-indicate it. 
Most care is needed in the use of spirit when the urine is 
scanty, or when there is violent delirium, with throbbing 
pains in the head. A few doses, however, will show whether 
the delirium is increased or diminished by its use. When 
its frequent administration is called for, care must be taken 
not to allow the patient to sleep too long without it. One is 
naturally unwilling to rouse a patient who may have pre- 
viously been without sleep for days, to give him his spirit 
and nourishment ; but unless we do so at each appointed 
hour, he may awake, and pass into a state of fatal pros- 
tration. 

When there are much general irritability and sleeplessness, 
in cases where there is no lung trouble, half a grain of ex- 
tract of opium may be given every three hours until the 
patient is calmed. If there is much headache, cold water, 
or iced water, may be freely applied to the head. 

After the first three or four days, the patient should not 
be allowed to use the night stool, or to get out of bed, but 
should be pi-ovided with a bed-pan, containing a little chlo- 
ride of lime. The bladder ought to receive daily attention, 
lest there be retention of urine. Under this management 
the patient may often remain in a very precarious state for 
some days ; but at last he will begin very gradually to 
recover, sleeping much as he improves. A teaspoonful of 
the quinine mixture R. 146, taken three times a day, with 



30 MEDICAL AND SURGICAL COMPANION. 

a gradual return to solid food, will ultimately complete 
the cure. 

During the whole course of the disease, no person should 
be allowed about the patient, except his attendants. 



HECTIC FEVER. 

This is a remittent fever, and generally depends upon some 
local source of irritation, especially if attended with an ex- 
haustiDg discharge, perhaps arising from the absorption of 
diseased secretions. It is in the advanced stages of con- 
sumption that hectic fever is developed in its most character- 
istic form. When abscesses are forming in the liver, hip- 
joint, &c, it usually occurs. 

Symptoms. Chills, succeeded by flushes, terminating in a 
hot skin and frequeut pulse, and these, by perspiration, con- 
stitute the paroxysm of hectic fever. There are usually two 
such paroxysms in the twenty-four hours. During the 
paroxysms the pulse is quick and frequent, ranging from 
ninety-six to one hundred and thirty, or even more ; the 
urine is high-colored, and deposits a pink sediment ; the 
cheeks have a florid, circumscribed redness ; there is burn- 
ing heat in the palms of the hands and soles of the feet. 
During the remission, the pulse is reduced in frequency, but 
seldom falls so low as in health. The appetite is not much 
impaired, and the tongue is clean, moist, and red. The 
patient rapidly loses flesh. 

Treatment. This must depend on the disease of which 
the hectic fever is a symptom. If there is no apparent dis- 
ease to produce the hectic symptoms, the treatment must be 
that of debility, and the quinine mixture (R. 146) will be 
an appropriate remedy. The general health should be im- 
proved in every way possible. 





r? 



Q 

o 




SMALL POX. 



31 



THE ERUPTIVE FEVERS. 

These are diseases attacking a person, for the most part, 
only once, beginning with fever, and followed, after a short 
and nearly definite interval, by eruptions upon the skin. 
They are, — 

Small Pox, ..... Variola. 
Chicken Pox, .... Varicella. 

Measles, ..... Rubeola. 
Scarlet Fever, .... Scarlatina. 



SMALL POX. 



This disease may be defined as a fever, commencing with 
lassitude, pain in the head and back, with more or less 
vomiting. On the third day from the commencement of the 
attack, an eruption of small, hard pimples begins to appear 
— first on the face, then on the neck and wrists, then on 
the body, and, lastly, on the lower extremities. In some 
instances it is accompanied by a similar affection of the 
mucous membrane of the nose and mouth. The pimples 
gradually ripen into pustules, the suppuration being complete 
by the ninth day, at which time the pustules break, and 
crusts or scabs form. In four or five days more these scabs 
begin to fall off. 

Now, the severity of the disease always bears a direct re- 
lation to the quantity of the eruption. When the pustules 
are distinct, and not very numerous, the disease is milder 
than in the confluent form, in which they are very numerous, 
especially on the face, where they run together, so as to 
form almost a complete scab. The pustules attain their full 
size about the eighth day, when they have a round, whitish 
look, reminding one of a quantity of peas half embedded 
in the skiu. About this time dark spots may be seen on 



32 MEDICAL AND SURGICAL COMPANION. 

the pustules, aud they soon break and discharge their con- 
tents ; and these, drying on the surface, form crusts, which 
in a short time fall off, and leave the skin beneath of a 
dark-brown color, which gradually fades out. During the 
course of this disease, the face, hands, and limbs often swell 
considerably. The patient is convalescent about the seven- 
teenth day. In the more severe cases, permanent white scars 
are left upon the skin of the face, aud other exposed parts 
of the body. 

The period occupied by the change from pimple to pustule 
is called the period of maturation. At different stages of 
this process, according to the amount of eruption, but gen- 
erally as early as the eighth day, secondary fever sets in, 
characterized by extreme restlessness, sleepless nights, a 
frequent and quick pulse, scanty and high-colored urine, 
and frequently by delirium, especially at night. 

Cause. A specific contagion, emanating from persons 
laboring under the disease, or from clothes, or other articles, 
worn or used by them. The disease manifests itself in 
about twelve days from the time of exposure. 

Treatment. The less drugs are used in the manage- 
ment of small pox the bettter, since they will neither shorten 
the disease nor exert any favorable influence upon it. In 
the early stages the patient should be kept quiet in bed, 
in a well-ventilated room; his diet should consist of milk, 
arrowroot, gruel, or weak beef tea ; he should be allowed 
plenty of lemonade, or barley water, or plain water ; and 
when the skin is very hot, sponging the surface of the body 
with warm water will prove very refreshing. If the bowels 
are confined, a Rochelle powder, or a little castor oil, may 
be occasionally given ; or if there be great irritability and 
nervousness, ten grains of Dover's powder at bed-time will 
do good ; or if the maturation or filling out of the pustules 
goes on slowly, good broths, or beef tea, and small quan- 
tities of brandy, are indicated. 

In treating the secondary fever, which, as before stated, 



KINE OR COW POX. 33 

sets in about the eighth day, keep the bowels gently open 
by mild laxatives ; administer five to ten grains of Dover's 
powder, if needful, once or twice a day, and support the 
system by a nourishing but digestible diet, such as strong 
beef tea, milk, the yolk of one or two eggs daily, &c. 
When there is great prostration, liberal and frequent doses 
of whiskey or brandy are demanded. To relieve the intol- 
erable itching, sponge carefully with R. 134, warm. To 
prevent pitting, glycerine, sweet oil, or cold cream may be 
used. When the pustules have burst, some dry powder, 
as the oxide of zinc, or powdered starch, should be freely 
applied to absorb the matter. 



VARIOLOID. 

This is small pox, modified by previous vaccination, the 
vaccine disease affording complete protection to only about 
one half of those subjected to it. Varioloid is capable of 
producing genuine small pox in the unprotected. In some 
cases the fever alone exists ; in others only an eruption 
going on to the fourth or fifth day, and then drying up. Its 
progress is always shorter, by several days, than small pox, 
and it is destitute of the characteristic odor of that disease. 
The treatment is the same as for mild cases of small pox. 



KINE OR COW POX. (Vaccinia.) 

The fatality of small pox has been very much diminished 
since the discovery of vaccination, by Dr. Jenner, towards 
the close of the eighteenth century. The disease was first 
noticed in the cow (whence its name), in which animal it 
appears in the form of small vesicles upon the teats. The 
matter taken from such vesicles, when introduced under the 
skin, sets up in the human system a very mild disease, 
3 



34 MEDICAL AND SURGICAL COMPANION. 

which is fully protective against small pox in one half the 
cases, and greatly modifies it in the other half. It is not 
now necessary to take this matter directly from the cow, 
but from some person who has the vaccine disease. The 
matter should be taken about the eighth day. 

MODE OF PERFORMING THE OPERATION OF VACCINATION. 

Two or three punctures should be made near each other, 
on the outside of one arm, about six or eight inches below 
the shoulder. The skin being made tense, a sharp lancet 
should be inserted obliquely downwards under the skin, so as 
to draw a single drop of blood. If the matter is taken di- 
rectly from the arm of another child, the lancet should be 
dipped in the lymph of the vesicle, and then inserted in 
the punctures. If the matter is on quill points, it should 
be first moistened by the breath. If portions of crust or 
scab are used, they must be carefully crowded into the punc- 
tures. 

On the second or third day small red spots appear, which 
gradually increase until they attain their full size, about 
the eighth day, from which time they gradually dry away, 
the crusts falling off about the fifteenth or twentieth day, 
leaving deep marks or indentations on the skin, of a cir- 
cular form, with as mauy pits as there were cells in each 
vesicle. 

Infants may be vaccinated at any time after the sixth 
week. Some have recommended the repetition of vacci- 
nation at intervals of a few years ; and I regard this as 
a wise precaution. No treatment is required. 



CHICKEN POX. 

This is a trifling complaint, almost peculiar to infants and 
young children. It runs its course in about a week. The 
disease consists of an eruption of transparent vesicles sur- 



CHICKEN POX. MEASLES. 35 

rounded by a slight redness, commencing on the shoulders 
and breast, affecting the scalp, but often sparing the face. 
These vesicles form small scabs, which rapidly dry up ; 
there is no constitutional disturbance of any importance, and 
the accompanying fever is slight. When the eruption is 
abundant, the body presents the appearance of having been 
exposed to a momentary shower of boiling water, each drop 
of which has caused a small blister. No treatment is neces- 
sary. 

MEASLES. 

The distinguishing characters of this disease are a con- 
tinued contagious fever, accompanied by an eruption, and 
frequently attended with inflammation of the mucous mem- 
brane of the respiratory organs. The eruption usually ap- 
pears about the fourth day. The period of incubation, or, 
in other words, the time which elapses between the period 
of infection and the appearance of the eruption, is from ten 
to fifteen days. 

Symptoms. Very much, at first, like those of a common 
" cold," or catarrh. These are lassitude, shivering, fever ; 
with affection of the mucous membrane of the throat, nose, 
windpipe, aud bronchial tubes. There is also swelling 
of the eyelids, eyes suffused and watery, and intolerant of 
light; sneezing; dry cough, with hoarseness, and at times 
diffculty of breathing ; drowsiness ; great heat of skin ; fre- 
quent and hard pulse. 

When the eruption first appears, it consists of small circu- 
lar dots, like flea-bites, which gradually coalesce into small 
blotches of a raspberry color ; they present, often, a horse- 
shoe shape, and are slightly raised above the skin. The 
rash appears first on the forehead and face, and gradually 
extends downwards ; it begins to fade on the seventh day, 
in the same order, and is succeeded by slight scaling of the 
cuticle, and great itching. 



36 MEDICAL AND SURGICAL COMPANION. 

It is worthy of notice that the fever does not abate on the 
appearance of the eruption, as in small pox ; nor does the 
severity of the attack at all depend upon the quantity of the 
rash. The contagion of measles is strong, but less power- 
ful than that of small pox. It is mostly seen in children ; but 
adults may have it, if they escaped in childhood. 

The usual duration of the disease is from nine to twelve 
days. 

The complications most to be feared in this disease are 
croup, bronchitis, and lung fever. The diarrhoea, which 
often sets in as the rash declines, is for the most part bene- 
ficial. 

Treatment. Exposure to cold to be carefully avoided. 
The patient should be confined to bed in an apartment mod- 
erately warm. Low diet, mucilaginous drinks, laxatives, 
and mild diaphoretics, may be had recourse to. The follow- 
ing mixture may be given with advantage : — 

Spirit of Mindererus, . . .1 ounce. 

Sweet Spirit of Nitre, . . .2 drachms. 

Paregoric, . . . . .2 drachms. 

Syrup of Gum Arabic, . . . jounce. 

Mix. A teaspoonful may be given to a child six years 
old, every four or six hours. For others, let the dose be in 
proportion to age. - 

If croup, severe bronchitis, or lung fever arise, treat ac- 
cording to the rules laid down for treating those diseases. 



SCARLET FEVER. 

This is a contagious and infectious fever, accompanied by 
a scarlet eruption, or rash, upon the skin, which usually 
makes its appearance on the second day, and terminates in 
scaling of the cuticle. More or less soreness and swelling 
of the throat are also present in the larger proportion of 




fV3 




SCARLET FEVER. 37 

cases. The disease makes its appearance in four to six days 
from the time of exposure. 

Symptoms. Chills, followed by a hot skin, rapid pulse, 
thirst, headache, nausea, and sometimes vomiting, restless- 
ness, and sleeplessness. On the second day, in the greater 
number of cases, a bright scarlet rash is perceptible on the 
face, neck, and arms, whence it extends over the trunk and 
limbs. It generally begins to decline on the fifth day, and 
wholly disappears by the eighth day. Entire duration of 
the disease from eight to thirty days, or more. 

Treatment. In simple scarlet fever, which is unac- 
companied by throat trouble, very little treatment is re- 
quired. The patient may be kept in doors for a few days, 
and allowed plenty of milk, arrowroot, &c. If very thirsty, 
a little plain water or lemonade may be given as often as 
occasion requires. Never allow the throat and mouth to 
become parched for want of water. 

Towards the decline of the disease, the bowels may be 
moved by some mild pui-gative, as castor oil or magnesia. 
In a more severe form of the disease, accompanied with 
some soreness and swelling of the throat, great heat of skin, 
&c, the patient demands a little more attention ; but in no 
case can we shorten the disease by treatment ; we can, 
however, relieve urgent symptoms as they arise. When the 
heat of skin is great, sponging the surface of the body 
once or twice a day with warm water will prove bene- 
ficial, and the following mixture will tend to lessen the 
fever : — 

Take of Spirit of Mindererus, . . 1 ounce. 

Sweet Spirit of Nitre, . . 2 drachms. 
Syrup of Gum Arabic, . . 6 drachms. 

Mix. Give half a teaspoonful to a teaspoonful, three or 
four times a day, to a child four to six years old. 

For the throat trouble, one drachm of powdered chlorate 
of potassa may be dissolved in a pint of water, and a few 



38 MEDICAL AND SURGICAL COMPANION. 

swallows taken every two or three hours. A flannel cloth 
passed several times around the throat may bo of some 
advantage, and I believe a hot flaxseed poultice to the 
throat will, in some cases, prove serviceable. If there is 
much debility, a little wine or brandy may be given three 
or four times a day. The tincture of chloride of iron may 
be given after the fever has declined. For a child three or 
four years old, four drops may be given, in a little water,- 
four times a day. 

In malignant scarlet fever, all the symptoms are aggra- 
vated, and the throat trouble is very severe. The vital pow- 
ers are so prostrated by the deadly force of the poison, that 
unless we support them by the free administration of brandy 
or wine, they will fail altogether. If we do the best we can, 
the larger number of cases may prove fatal. 

In these cases, swabbing out the throat once or twice a 
day, for several days, with a solution of the crystals of 
nitrate of silver, will generally prove useful. The solution 
should be quite strong — forty to sixty grains to an ounce 
of water. A hot flaxseed poultice may be applied to the 
throat. Sometimes I have painted the throat outside with 
tincture of iodine, once or twice a day, for several days, 
with apparent benefit. For diet, good beef tea and milk 
may be freely given. 

Beware of giving cathartics too early in this disease, for 
it is one in which the powei-3 of life must be supported, 
instead of lowered. If the bowels are constipated at the 
commencement, a gentle laxative only should be given. 

Mothers should be very careful of their children for three 
or four weeks after they have had scarlet fever, lest they 
take cold, which is liable to cause kidney and dropsical 
trouble of a serious nature. 



ACUTE RHEUMATISM. 39 



CHAPTER III. 
ACUTE RHEUMATISM. 

This disease consists of an inflammation of the larger 
joints, accompanied by well-marked fever symptoms ; the. 
inflammation often shifting from joint to joint, and in many 
cases attacking the fibrous textures of the heart. 

Symptoms. The disease generally sets in soon after ex- 
posure to cold and wet, with all the symptoms of a " cold ; " 
the pain in the back and limbs being unusually severe, and 
accompanied by a sensation of coldness and stiffness. In 
the course of two or three days, inflammation shows itself in 
one or more of the larger joints of the body, characterized 
by redness and heat of surface, acute pain, extreme tender- 
ness, swelling, and tension. There is great constitutional 
disturbance, with extreme restlessness, intense thirst, and 
loss of appetite. The pulse ranges from ninety to one hun- 
dred and twenty, and is full, hard, and jerking. The skin 
is often bathed in a profuse acid sweat, which, however, 
affords no relief. There is constipation in most cases, and 
the urine is high-colored and scanty. This disease is rarely 
confined to the joints first attacked ; but after some hours or 
days, it attacks other joints, sometimes continuing in those 
first affected, at others leaving them quite free from pain 
and swelling. In rarer instances, it returns to the joints 
first affected, and ultimately extends to all the larger joints 
of the body. Some amendment usually takes place at the 
end of two or three weeks ; the pain lessens ; there is less 
fever and less perspiration; the urine is more abundant; 



40 MEDICAL AND SURGICAL COMPANION. 

the appetite returns ; the thirst diminishes ; the pulse falls ; 
and the patient's movements become more free. 

In many cases the disease extends to the fibrous tissues 
of the heart. The symptoms which denote this formidable 
complication are difficulty of breathing, palpitation, pain in 
the region of the heart, &c. 

Cause. The disease is supposed to depend upon an excess 
of lactic acid in the blood. The exciting cause is exposure 
to wet and cold. 

Treatment. At the commencement it is advisable to 
give a thorough purgative, which may consist of eight grains 
of calomel and fifteen of jalap. During the whole course of 
the disease the bowels should be kept rather loose, by giving 
every day or two, either a Rochelle powder or a small quan- 
tity of Epsom salts. Opiates in full doses are generally neces- 
sary to relieve the pain and general irritability. A pill, com- 
posed of two grains of opium, may be given every night ; ami 
unless the patient perspires freely, one of the following pow- 
ders may be given once in four or six hours during the day. 

Take of Powdered Opium, . . .6 grains. 

Powdered Ipecac, . . .6 grains. 

Powdered Nitrate of Potassa, . 48 grains. 

Mix thoroughly and divide into twelve powders. 

In addition to the foregoing, the following mixture will 
prove very beneficial in most cases : — 

Take of Bicarbonate of Potassa, . . 1 ounce. 

Peppermint water, . . . C ounces. 

Syrup of Orange Peel, . . 2 ounces. 

Mix. A tablespoonful may be taken every third hour, for 
two or three days, after which one half the quantity may be 
given, until the pain and fever are very much lessened. If 
the disease remains stationary in one or two joints, a couple 
of grains of iodide of potassium may be advantageously ad- 
ministered with each dose. During convalescence, II. G2 
or R. 63 may be taken with benefit. The diet must at 



CHRONIC RHEUMATISM. 41 

first be low, consisting of gruel, arrowroot, &c. Whenever 
signs of depression are observed, good beef tea and milk 
may be administered, with, if necessary, brandy and water. 
Light puddings, potatoes, and fish should be allowed as soon 
as the appetite returns, and the stomach appears capable of 
digesting them. As soon as convalescence is thoroughly 
established, mutton, beef, and poultry may be given. In 
the early stages, when there is much thirst, a plenty of lem- 
onade may be allowed. 

Local Remedies. When the wrists and ankles are chiefly 
affected, much benefit will arise, from frequently soaking them 
in a warm alkaline bath ; or from fomenting them with 
warm water, to which a little bicarbonate of soda and lauda- 
num have been added. Rubbing the parts two or three 
times a day with opium liniment often proves serviceable. 
Wrapping the affected joints in cotton wool and oiled silk 
frequently gives relief. When the acute symptoms have 
partially subsided, the swollen joints may be painted with 
tincture of iodine. 



CHRONIC RHEUMATISM. 

This is sometimes the sequel of rheumatic fever, but fre- 
quently a separate constitutional affection, coming on quite 
independently of any previous acute attack. It is quite 
common in people past the meridiau of life, few old persons 
being entirely ignorant of its symptoms. 

In chronic rheumatism the fibrous textures around the 
joints, or the fibrous envelopes of the nerves, or the aponeu- 
rotic sheaths of the muscles, the fasciae, or the periosteum, are 
the parts that suffer. Whichever tissue may be affected, 
there is, at first, only slight constitutional disturbance ; but 
the sufferer is constantly annoyed, and his existence at length 
made miserable, with chronic pains, causing him to be rest- 
less at night, and destroying all comfort during the day. 



42 MEDICAL AND SURGICAL COMPANION. 

There are two or three different forms of chronic rheuma- 
tism. Thus rheumatic inflammation of the lumbar fascia is 
termed lumbago, the pain being referred to the fleshy mass of 
muscles on one or both sides of the loins, and being increased 
by every movement of the back. Stiff or wry neck is another 
variety, generally due to sitting in a draught. In sciatica 
the suffering is due to disease affecting the sheath of the sci- 
atic nerve. "When the muscles between the ribs, or tlie 
fibrous fascia? lining the chest, are affected, the di- 
frequently called Neurodynia. The " stitch " which follows 
a deep inspiration must not be mistaken for the lancinating 
pain of pleurisy. 

Treatment. In the treatment of chronic rheumatism 
'it is always necessary to attend to the geueral health, as by 
so doing the disease will generally be materially mitigated. 
Care must be taken that the function of digestion is per- 
formed naturally; while sleep must be afforded by opiates, 
if necessary. There are several remedies that have proved 
beneficial in this disease, but I cannot in this work mention 
them all. The iodide of potassium, and the cimicifuga ra- 
cemosa or black snalceroot, will be found very efficacious in 
the majority of cases. 

Take of Iodide of Potassium, . . 8 scruples. 

Fluid Extract of Cimicifuga, . 2 ounces. 
Syrup of Gum Arabic, . . 2 ounces. 

Mix. A teaspoonful may be taken in a wineglass of water 
three times a day, after meals. 

Local applications, such as blisters (R. 80), iodine paint 
(R. 8G), and chloroform and opium liniment (R. Ill), often 
give temporary relief. In lumbago, a large belladonna 
plaster, applied over the whole loins, will often be productive 
of great comfort. Ironing the part, a piece of paper or 
cloth being placed between the hot iron and skin, deserves 
mention. All sufferers from chronic rheumatism should 
wear flannel, and beware of exposure to wet and cold. 



43 



SCIATICA. 

This disease is a form of neuralgic rheumatism, and con- 
sists of acute pain following the course of the great sciatic 
nerve, extending from the hip down the back of the thigh to 
the knee, and frequently along the nerves of the leg to the 
foot. 

Causes. Rheumatism ; pressure upon some part of the 
nerve, such as may arise from intestinal accumulations, or 
from simple or malignant tumors of the womb ; and occa- 
sionally from inflammation. 

Usually one limb only is affected. The muscles feel stiff, 
and as if their action were impeded, so that the patient 
limps along with the aid of a stick. The duration of sciat- 
ica varies from a few weeks to several months or years. 
The middle period of life, from forty to sixty, is most ob- 
noxious to it ; and occasionally attacks of it alternate with 
other rheumatic or neuralgic affections. 

Treatment. Remove the causes, if they can be ascer- 
tained. If it has a rheumatic origin, the treatment recom- 
mended for chronic rheumatism will prove beneficial. 



GOUT. {Podagra.) 

Gout may be defined as a specific inflammation, having a 
constitutional origin, and being much favored by an heredi- 
tary taint. 

Symptoms. The acute attack may be preceded by pre- 
monitory symptoms, or it may come on suddenly. In the 
former case, the patient complains, for two or three days 
prior to the seizure, of heartburn and flatulence, and of dull 
pains in the left side of the chest, with inability to lie com- 
fortably on that side. 

Very often, however, there is no warning. The victim 



44 MEDICAL AND SURGICAL COMPANION. 

goes to bed apparently well, but towards morning awakes 
with a severe burning and throbbing pain in the ball of the 
great toe, or in the heel, or the fascia? covering the instep of 
the foot, or the thumb. There is often a slight chill, suc- 
ceeded by heat. The pain is most excruciating; but it 
abates near the dawn, and the patient falls asleep. On 
again awaking, the affected part is found red, swollen, aud 
exquisitely tender to the slightest touch. The sufferer is 
feverish, restless, very irritable, aud much depressed ; his 
bowels are constipated, and his urine scanty and high- 
colored. The bladder is often irritable, so that it has to be 
emptied frequently, while the urine in its passage gives rise 
to a sense of heat in the urethra. 

In a few days, sometimes almost in a few hours, the at- 
tack passes off, and the patient is well; often better, indeed, 
than he has been for a long time previously. But the dis- 
ease will return. At first two or three years may elapse ; 
with each paroxysm, however, the interval will shorten, 
until at length, perhaps, the patient is hardly ever i're? from 
an attack, except it may be for a few weeks in summer. 
At first, also, it confines itself to a single joint ; by degrees 
several joints in both feet or in the hands suffer. Deposits 
are formed around aud outside the joints of a material re- 
sembling moist chalk, and consisting of lilhate of soda. 
Gout sometimes leaves a joint, and goes to some internal 
organ, more especially to the stomach. It is then called 
retrocedent gout. 

This disease may be distinguished from rheumatism by 
the seat of the disease being the smaller joints, especially 
the great toe ; by the more intense color of the inflamed 
part ; by its more sudden attacks. 

Causes. It is often hereditary, but more frequently ac- 
quired by a luxurious mode of living, sedentary habits, and 
over-mental toil and anxiety, especially when stimulants are 
resorted to for the purpose of making this toil more support- 
able. It generally begins between thirty and forty years 



GOUT. 45 

of age. Women are much less liable to this disease than 
men. 

Treatment. The treatment of gout naturally divides 
itself into that proper during an attack, and that to be 
adopted in the interval. At the commencement of the at- 
tack, the bowels may be moved by a Rochelle powder, or 
dose of Epsom salts. This may be repeated every second 
day, if necessary. 

The preparations of colchicum prove very beneficial in 
this disease, and may be given in combination with some 
alkali and laudanum. The following is a good prepara- 
tion : — 

Take of Bicarbonate of potassa, . 6 drachms. 

Tincture of opium, . 4 " 

Wine of colchicum seed, . 12 " 

Liquid acetate of ammonia, 10 ounces. 

Mix. An adult may take a tablespoonful in a little 
water, three times a day. 

The dose may be diminished as the inflammation abates, 
and it may be given in small doses, of from one to two tea- 
spoonfuls, for a week or two after the disappearance of the 
malady. 

The local treatment may be the same as recommended for 
rheumatism. This disease may be prevented by regular 
living, avoiding the exciting causes of the disease, by ab- 
stinence from liquors, and the moderate use of animal food, 
and by a milk and vegetable diet, friction with the flesh- 
brush, regular exercise, bathing, the regular use of mild 
laxatives, and when dyspeptic symptoms are present, the 
treatment applicable to that disease. 

Treatment of Ketkocedent Gout. If the stomach is 
attacked, apply a mustard poultice over that region, and 
soak the i'cet in hot mustard water. Warm brandy and 
water may be taken rather liberally. 



46 MEDICAL AND SURGICAL COMPANION. 



SCROFULA. 

By the term scrofula is understood a peculiar state of 
constitution, characterized by want of power and tone ; the 
deposit of a substance called tubercle in several organs of 
the body, and a tendeucy to indolent inflammatory swellings 
and chronic ulcers. 

The most common forms of scrofulous disease, are chronic 
inflammation and suppuration of the glands of the neck, 
enlarged tonsils, " white swelling," and pulmonary con- 
sumption. 

The form of scrofula to be described in this place is that 
which attacks the absorbent glands of the neck. Other 
scrofulous affections will be treated of elsewhere in these 
pages. 

Symptoms. This disease most commonly affects children 
of a las habit of body, with a smooth, soft skin, delicate, 
rosy complexion, fair and fine "hair, large blue eyes, and full 
upper lip. A less common combination is the dark hair and 
olive complexion. The subjects of this disease often display 
great acuteuess and aptitude, with lively imaginations and 
ardent affections, and not unfrequently a great precocity of 
intellect. 

The scrofulous affection of the glands of the neck first 
appears as a slight swelling of one or more of the glands of 
one or both sides of the neck, especially of those situated 
beneath the lower jaw. The tumor is even to the touch, 
not tender, nor marked by any inflammation of the skin. 
Sometimes the swollen gland, or glands, will remain in this 
state without perceptible change for weeks, months, or even 
years. Sometimes, under proper treatment, they gradually 
disappear. In the large majority of cases they proceed to 
suppuration, when pus and a curdy or cheesy matter is dis- 
charged. The abscess thus formed heals slowly, has an 
unhealthy appearance, a dull red color, with hard, swollen, 



SCBOFULA. 47 

irregular edges, and an uneven base, clogged with curdy- 
matter. The constitutional disturbance which accompanies 
these local changes is often slight. The patient frequently 
has every appearance of good health. In some cases there 
is general debility, emaciation, and loss of appetite. In 
advanced stages of the disease, especially in young adults, 
pulmonary consumption may supervene, and the two dis- 
eases run together until they destroy the patient. 

Causes. Hereditary taint, syphilis, or gout, or a shat- 
tered constitution in one or both parents, disparity of age, 
scanty and unwholesome food, and impure air. 

Treatment. In treating this disease we must endeavor 
to improve the general health, promote the absorption or 
dispersion of local tumors, and the healing of ulcers. 

A nutritious diet, adapted to the age of the patient, with 
a due allowance of animal food, will be required. During 
the formation of matter, wine and malt liquors, in mod- 
erate quantity, may be given with advantage. 

Daily exercise, short of fatigue, is beneficial. The cloth- 
ing should be warm, and flannel should be worn next the 
skin. 

Change of air, especially from a low, damp situation to a 
high and dry one, is advisable. Sea air and sea bathing in 
the summer and autumn months may prove advantageous. 
Daily ablution of the skin with cold or tepid water, fol- 
lowed by friction with a coarse towel, will do good. 

The bowels may be regulated by laxatives, if necessary. 
The preparations of iron (R. 59, 60, 63) and iodine (R. 67, 
68) may be given with advantage in all cases. Cod-liver 
oil is a valuable remedy in this disease. Simple enlarge- 
ment of the glands of the neck may be treated by giving 
R. 67, and frequently applying to the tumor the iodine 
paint. 

Open scrofulous ulcers may require to be touched with 
lunar caustic, and afterwards a poultice or resin ointment 
may be applied. 



48 MEDICAL AND SURGICAL COMPANION. 



ANEMIA, CHLOROSIS. 

This is a disease dependent on a decrease of the red par- 
ticles and solid constituents of the blood. It usually comes 
on gradually. 

Symptoms. Universal paleness of the skin, tongue, gums, 
and lining membrane of the mouth ; cold extremities, debil- 
ity, fainting fits, palpitation, and difficulty of breathing on 
the slightest exertion, headache, pain under the left breast, 
or a sense of fulness in the chest, pulse frequent, small, and 
quick, increased by exertion and motion. The patient is 
easily agitated by slight noises and unexpected events, and 
suffers from depression of spirits, and in some cases from 
hysteric fits. The bowels are generally torpid. This dis- 
ease occurs oftener in females than males, and is generally 
in some way connected with the function of menstruation. 

In males it may be occasioned by overwork, as in bakers, 
and other men following exhausting occupations, without 
sufficient time for rest and refreshment. 

Treatment. Remove as far as possible the causes of the 
disease, and administer the preparations of iron (R. 59, 
61 or 63) for a considerable time. 

The diet should be substantial ; good beef, mutton, and 
poultry are excellent. Out-door exercise short of fatigue, 
the respiration of pure air, and cool bathing, particularly 
in sea water, will prove serviceable. 

If the bowels are constipated, they may be kept regular 
by taking, every second or third night, two or three of the 
pills of aloes and myrrh. 



INFLAMMATION OF THE BRAIN. 49 



CHAPTER IV. 
DISEASES OF THE NERVOUS SYSTEM. 

INFLAMMATION OF THE BRAIN. 

Symptoms. Intense pain in the head ; the eyes incapable 
of bearing the light ; delirium ; face flushed ; oppression of 
the breast ; the pulse hard and very rapid ; tongue at first 
fiery red, then yellow, brown, or black. 

Causes. Excessive heats, or great vicissitudes of temper- 
ature ; exposing the head uncovered to the sun {coup de 
soleil), violent exercise, excited passions of the mind, ex- 
ternal violence, the abuse of spiritous liquors, metastasis 
of gout, rheumatism, erysipelas, small pox, measles, scar- 
let fever ; whooping-cough, teething, &c. 

Treatment. To an adult give a purgative, composed of 
five grains of calomel and fifteen of jalap. In three or four 
hours after this is taken, give a tablespoonful of Epsom 
salts, dissolved in a tumbler of water. Repeat the purge 
every day or every second day, according to the urgency of 
the case. 

The application of cold to the head, after it has been 
shaved, is a remedy of great importance. Pounded ice in a 
bladder, or the constant application of cold water, or iced 
water, will often be followed by the most happy results. Rice 
water, barley water, lemonade, or cold water, should be the 
only diet, until the symptoms begin to abate. The patient's 
room should be well ventilated, but darkened, and should 
be kept quiet, as very slight noises will disturb him. 



50 MEDICAL AND SURGICAL COMPANION. 

When, from exhaustion of the nervous force, an extreme 
degree of prostration occurs, brandy or R. 43 should be 
given, as occasion requires, and strong beef tea and milk 
may be freely taken. 



WATER IN THE HEAD. (Acute Hydrocephalus.) 

This is a common disease of children under five years 
old. It generally occurs in feeble, scrofulous children, but 
may occur in others. 

Symptoms. The symptoms are somewhat various and 
uncertain. There is fever, appetite variable, the tongue 
furred, the breath offensive ; there is often nausea and 
vomiting, and the bowels are disordered — generally consti- 
pated. The child is drowsy, yet restless ; it sleeps badly, 
moans, grinds its teeth, screams, and awakes suddenly in 
alarm, without any apparent cause. la four or five days, 
if the disease is unchecked, its nature becomes apparent, and 
its cure almost hopeless. The child at this stage wishes to 
remaiu quiet in bed ; its countenance is expressive of anxi- 
ety and suffering ; its eyes are closed, and eyebrows knit ; 
and it is annoyed by light and noise. If old enough to reply 
to questions, it complains of headache, weariness, and sleep- 
iness ; crying out frequently, " O, my head ! " As the dis- 
ease advances, the pulse falls rapidly, sometimes from one 
hundred and twenty to eighty in a few hours ; the slightest 
exertion however accelerates it. Stupor and heaviness soon 
come on ; there is often squinting ; convulsions frequently 
occur, and sometimes paralysis. At the end of a week or 
two the child may pass into a profound sleep, or stupor, from 
which it is impossible to rouse him. Sometimes convulsions 
put an end to the painful scene. 

Treatment. This disease is one of the most serious to 
which children are liable, and when it is suspected, send for 
a physician at once, if one is to be obtained. 



APOPLEXY. 51 

Keeping the bowels open, and the constant application of 
cold water to the head, are approved measures of treatment ; 
but the disease generally terminates fatally. 



APOPLEXY. 

By"apoplexy, is understood sudden insensibility — the loss 
of sensation, thought, and power of voluntary motion ; to- 
gether with more or less severe disturbance of the functions 
of respiration and circulation. 

Symptoms. Falling without sense or motion ; profound 
sleep ; face livid or flushed ; eyes wide open, or half closed, 
and immovable ; stertorous breathing, &c. 

Causes. The excessive use of intoxicating drinks, tobac- 
co, opium ; a rush of blood to the head, from any cause ; 
violent exercise ; sudden excitement ; intense heat ; anger, 
&c. 

An attack of apoplexy may gradually pass off, leaving 
the patient well, or it may terminate in incomplete recovery, 
the mind being impaired, and some parts of the. body para- 
lyzed ; or it may end in death. 

Persons whose ancestors have suffered from the disease, 
and fleshy individuals, with short, thick necks, are most sub- 
ject to this disease. Persons beyond fifty years of age are 
most liable to it. 

This dreadful disease is seldom experienced without some 
previous threatenings ; which, properly interpreted, should 
put the patient on his guard. Among the warnings are 
headache and giddiness, experienced particularly on stoop- 
ing ; a feeling of weight and fulness in the head, with 
noises in the ears and temporary deafness, transient blind- 
ness, or sometimes double vision ; repeated bleeding from 
the nose ; fits of nausea, and a sense of numbness in the 
limbs ; loss of memory ; partial paralysis, sometimes affect- 
ing a limb, sometimes the muscles of the face, sometimes 
the tongue or eyelids. 



52 MEDICAL AND SURGICAL COMPANION. 

Persons who have these warnings must carefully guard 
against everything liable to bring on an attack. They should 
live sparely, and avoid the use of spirits, tobacco, and 
opium ; tight neckcloths, straining at stools, long-continued 
stooping, excitement, &c. In most cases of death from apo- 
plexy there is an effusion of blood (from the rupture of 
some small artery), upon or between the membranes of the 
brain. 

Treatment. When a person falls in an apoplectic fit, 
if the vessels of the neck are congested, and if the face be 
flushed and turgid, bleeding may be resorted to. But if the 
patient is feeble, and has an almost imperceptible pulse, and 
a cold, clammy skin, bleeding will only insure a speedy 
fatal termination. In either case the patient ought be re- 
moved into a cool, well-ventilated room ; his head should 
be well raised ; all the tight parts of his dress must be 
loosened, especially his cravat and shirt collar ; and cold 
water, or pounded ice in a bladder, applied to his head. His 
feet may be put into a vessel of very warm mustard-water at 
the same time. If it be a case requiring bleeding, it should 
be done at once, by opening a vein at the bend of the arm 
or in the foot, and half a pint to a pint of blood be allowed 
to flow. 

Active purgatives are very serviceable. Three or four 
drops of Croton oil, made into a pill with a crumb of bread, 
should be given at once. An injection, R. 12, should also 
be given immediately. These cases admit of no delay. 
Supposing a patient to recover from the fit, great care will 
afterwards be required to prevent a second attack. 



SUN STROKE. (Coup de Sohil.) 

This disease is allied to apoplexy. It proceeds from 
exposure to the sun's rays. 

Symptoms. These are, generally, faintness, thirst, great 



DELIRIUM TREMENS. 53 

heat, and dryness of skin, with prostration. Sometimes the 
patient is suddenly prostrated as in apoplexy, and dies at 
once ; at other times the disease comes on very insidiously. 
A man will be seen to be listless and stupid, but he makes 
no complaint beyond saying that his head feels a little queer. 
Yet in twelve hours he may be dead. 

Treatment. Apply cold to the head perseveringly, and 
warmth to the extremities, as in apoplexy. If prostration 
becomes very great, spirits may be given, and the applica- 
tion of cold to the head discontinued. In such cases send 
for a physician as soon as possible. 



DELIRIUM TREMENS. 

This is quite a common disease, and generally arises from 
the excessive use of ardent spirits, wine, or beer. The 
habitual use of opium, and excessive mental excitement, 
may cause it. Men are very much more subject to it than 
women. 

Symptoms. This disease is characterized by sleepless- 
ness ; a busy but not violent delirium ; constant talking or 
muttering ; a trembling of the hands ; and general excited 
and eager manner. If questioned about his disease, he will 
answer readily and to the point ; describe, in an agitated 
manner, his feelings, put out his tongue, and do whatever 
you ask him. But soon afterwards his mind wanders 
from the scene around him to some other that exists only in 
his imagination. His thoughts generally appear to be dis- 
tressful and anxious ; perhaps he gives orders that relate to 
his business, to persons who are absent ; or he is devising 
plans to escape from some imaginary enemy ; at times he 
fancies that " little devils," rats, mice, reptiles, &c, are run- 
ning over his bed, or that strangers are in his room. He 
looks suspiciously behind the curtain, or under his pillow, 
and he is perpetually wautiug to get out of bed, but is gener- 



54 MEDICAL AND SURGICAL COMPANION. 

ally readily induced to lie down again. It is not often that 
he meditates harm, either to himself or to others ; there is, 
rather, a mixture of cowardice and dread with the delirium. 
Sometimes, however, he will be obstinate, and inclined to 
get out of the house, even if he has to jump from a 
window. In such cases the watchful care of attendants is 
required. 

Treatment. The great object is to induce sleep ; and 
for that purpose give a morphine pill, R. 45, every hour, 
until three have been given, unless the patient falls asleep 
before the third hour has expired. At the same time stimu- 
lants are necessary, and, as a rule, that stimulant will be 
most beneficial to which the patient has been accustomed. 
Thus, if whiskey is his favorite liquor, give him that ; but 
if most accustomed to brandy, administer it now. When 
there is great prostration, good beef tea and milk should be 
freely given. 

Occasionally it is necessary to restrain the patient's move- 
ments by strapping him to his bed, or by putting on a strait 
waistcoat. This should never be done, however, if it can 
possibly be avoided, as it always increases the excitement 
and prevents sleep. It will be much better to have one or 
two attendants at the bedside to quietly control him. The 
apartment occupied by the patient should be kept quiet, a 
little darkened, and well ventilated. 



INSANITY. 

Insanity is a general term used to express the mental con- 
dition opposed to sanity, — sanity being that state of mind 
which enables a man to discharge his duties to his God, his 
neighbor, and himself. This definition is open to many 
objections, and every definition will be so. For as nothing 
can be more slightly defined than the line of demarcation 
between sanity and insanity, so, if we make the definition 



INSANITY. 55 

too narrow it becomes meaningless ; and if too wide, the 
whole human race may be involved in it. 

Varieties of Insanity. The following classification is, 
perhaps, as simple and intelligible as any : Mania, Monoma- 
nia, Dementia, and Idiocy. It must be remembered, howev- 
er, that the differences between these varieties are almost 
always indistinctly marked, and that the various forms fre- 
quently run into each other. 

Mania. Mania, or raving madness, is characterized by 
general delirium. The reasoning faculty, if not lost, is dis- 
turbed and confused ; the ideas are abundant, erroneous, 
absurd, wandering, — not under control. The manners are 
violent, excited, mischievous. 

Although mania does not always make its incursions sud- 
denly, it is that form of insanity which most frequently does 
so. From its commencement the delirium is general, and 
the fury often extreme. Then it is that maniacs frequently 
destroy themselves ; either from not knowing what they do, 
or from despair, being conscious of their condition, or from 
accidentally injuring themselves. 

In general, maniacs soon become weak and emaciated. 
The mere physical exertion which they go through, some- 
times shouting, howling, laughing, reciting, &c, for hours 
together, often restless, constantly and rapidly moving about, 
would quickly exhaust a strong man. Combined with this 
fatigue is a want of refreshing sleep, and not unfrequently 
an aversion to all food. When recovery takes place it is 
preceded by sleep, a desire for food, and a gradual cessation 
of the agitation and delirium. 

Puerperal Mania is a peculiar affection, sometimes oc- 
curring to women about the fourth or fifth day after delivery. 
In most cases there is considerable debility. The delirium 
is often violent, and there is great general irritability. 

Treatment. These cases of puerperal mania require 
peculiar care. The indications are to rouse and support 



56 MEDICAL AND SURGICAL COMPANION. 

the powers of the patient, and to allay the irritability of the 
brain and nervous system. 

Good milk and beef tea, and wine or brandy, may gener- 
ally be used to advantage. To allay irritability and promote 
sleep, a morphine pill, R. 45, may be given, and repeated in 
four to six hours, if necessary. Lupulin, in drachm doses, 
often proves useful when given two or three times a day. 

The patient must be controlled effectually, but mildly, by 
a good nurse, accustomed to the management of these cases ; 
and when the disease threatens to be of considerable dura- 
tion, she should be separated from her family and friends. 

Monomania. Monomania, or partial insanity, is that form 
in which the understanding is partially deranged, or is under 
the influence of some particular delusion. The mind is vig- 
orous, the ideas are few, erroneous, fixed, not under control. 
The manners are in accordance with the predominant idea 
or train of ideas. At one time the intellectual disorder is 
confined to a single object, or a limited number of objects. 
The patients seize upon a false principle, which they pursue 
logically, and from which they deduce legitimate consequen- 
ces, which modify their acts and affections. Thus, a mono- 
maniac will insist that his body is made of glass, and being 
thoroughly impressed with this idea, will reason correctly 
that slight causes will injure it ; he constantly walks with 
care, and avoids any rough handling. Aside from this 
partial delirium, he often thinks, reasons, and acts like other 
men. Another monomaniac will fancy himself possessed of 
a demon, or evil spirit, or will believe himself to be a god, 
imagining that he is in communication with heaven. 

That form of monomania which is characterized by fear, 
moroseness, and prolonged sadness, has been separately 
described by some as melancholia. Such cases are pain- 
ful to have charge of, the despondency is often so great. 
Such persons are occasionally bent on committing suicide, 
and will often resort to modes of destructiou such as baffle 
all ordinary precautions. 



INSANITY. 57 

Kleptomania is another form of monomania, in which the 
individual seems to have an irresistible desire to steal. Py- 
romania is another form, in which the person has a propen- 
sity to set houses on fire. The two latter forms are some- 
times treated of under the head of moral insanity. Perhaps 
in some of these cases the term depravity would be more 
appropriate than that of insanity. 

Dementia. Dementia, or incoherence, is that condition in 
which weakness of the intellect, induced by age or accident, 
is the prominent feature. The mind is altogether weak ; the 
ideas are confused, vague, obscure, incoherent, unfixed, and 
the memory is impaired. The patients are ignorant of time, 
place, quantity, &c. They forget in a moment what they 
have just seen or heard. Their manners are undecided, 
childish, and silly. They see their best friends and rela- 
tions without pleasure, and they leave them without regret. 
The ultimate tendency of mania and monomania is to pass 
into dementia, which is rarely cured. 

Idiocy. This condition is characterized by partial or 
complete absence of the intellect, either from date of birth, 
or occurring in early life. The mind is not developed ; 
there are no ideas, -or they are few. The manners are child- 
ish, with occasional gusts of passion. The countenance is 
vacant, and void of aught approaching to intelligence. 

Causes of Insanity. The causes of insanity are often 
difficult to detect. ' It is no doubt frequently hereditary ; or 
it may be traced to marriages among near relatives ; or it 
may, perhaps, be due to syphilis in the system of the parents, 
or to drunkenness on their part. The more immediate 
causes may be injuries of the head, abuse of alcohol or nar- 
cotics, as tobacco and opium, sexual excesses, and particu- 
larly masturbation ; defective nutrition, long protracted 
watcbings and loss of rest, fevers, the retrocession of eiysip- 
elas or gout in persons predisposed to insanity. Then there 
are certain moral causes, as blighted ambition, disappoint- 
ment in love, perverted religion, immoderate grief, long- 



58 MEDICAL AND SURGICAL COMPANION. 

continued anxiety and distress, prolonged intellectual exer- 
tion, and pecuniary reverses. 

The age at which insanity appears to be most common, is 
between twenty and forty ; in women, perhaps, between 
twenty and thirty, in men between thirty and forty. 

General Treatment of Insanity. When a person is 
thought to be insane, the case should be submitted to some 
reliable physician for examination ; and if he confirms the 
suspicion, abide by his judgment in regard to the manage- 
ment of the patient. 

As regards the medical treatment, it must of course de- 
pend upon the state of the patient ; but it may be positively 
asserted that under no circumstances should a lowering or 
reducing system be pursued. Our object clearly must be to 
restore and maintain the general health. In an ordinary 
case of insanity, I should especially take care that the 
patient had a nutritious diet, warm clothing, exercise in the 
open air, healthy and regular evacuations from the bowels, 
and sound sleep at night. At the same time no mechanical 
restraint is to be resorted to ; and such cheerful occupation 
and mental amusement should be afforded as the patient 
could beneficially enjoy. 

Where patients obstinately refuse their food, strong beef 
tea mixed with wine, and gruel or milk, must be introduced 
into the stomach, by means of, the stomach pump. As re- 
gards the moral treatment, no rules can be of universal 
application. I will only say, therefore, that it should be 
regulated by the " law of love ; " and that no harshness, or 
means which induce fear, should be tolerated. The patient 
should be controlled, when possible, by firmness and kind- 
ness, rather than by coercion. In order to render restraint 
necessary, a lunatic should be in such a state as to be dan- 
gerous to himself or to others. It is undoubtedly true that 
many asylums contain harmless lunatics, who would be much 
happier, and in no degree injured, by a residence elsewhere, 
but who, unfortunately, have relations and friends who will 
not be troubled with them. 



HEADACHE. 59 



HEADACHE. (Cephalalgia.) 

Headache is of common occurrence, as a prominent symp- 
tom in the progress of most acute, and of many chronic 
diseases. Occasionally, however, it predominates so much 
over the other phenomena, that instead of being a symptom, 
it really becomes a disease. 

Three varieties of headache may be noticed. First, the 
Plethoric Headache, which is connected with fulness of 
blood ; the vessels of the head become congested ; there is a 
sense of pulsation in the ears, and giddiness on stooping. 
Persons who live too high, who rise late in the morning, 
&c, are liable to it. Plethoric young women, with irregu- 
larity of the menstrual function, are also subject to it. 

The Second, or Bilious Headache, may be temporary or 
constant. When temporary, it generally arises from some 
error of diet, some excess either in food or wine, and passes 
away when the cause ceases. The constant bilious head- 
ache occurs in persons of weak stomach, who are almost 
always suffering from dyspepsia or indigestion. 

The Third, or Nervous Headache, is generally due to de- 
bility and exhaustion. Sometimes it assumes an intermittent 
form, and is then characterized by its tendency to recur 
every day, or every second day, with the same degree of 
regularity as an ague fit. It is often due to constitutional 
debility. It is sometimes caused in women by over-nursing. 

Treatment. In treating Plethoric Headache, administer 
a thorough purgative, put the patient's feet in hot water, and 
apply cold water to the head. It is also well to observe a 
low diet for a day or two. 

The Bilious Headache will disappear when the digestive 
organs are put in good condition. If the patient is dyspep- 
tic, treat him for that disease. 

The Nervous Headache will disappear when the general 



DU MEDICAL AND SURGICAL COMPANION. 

health and strength have been improved. A nourishing diet, 
and tonics R. 63, R. 146, will prove beneficial. 



PARALYSIS. PALSY. 

By paralysis, or palsy, is understood a total or partial loss 
of sensibility or motion, or of both, in one or more parts of 
the body. All paralytic affections may be divided into two 
classes ; the first, including those in which both the power 
of motion and the sense of feeling are affected ; the second, 
those in which the one or the other only is lost or dimin- 
ished. The former is called perfect, the latter imperfect 
paralysis. Imperfect paralysis is divided into paralysis of 
motion, and paralysis of sensibility. Again, the paralysis 
may be general or partial, as it affects the whole body or 
only a portion of it. Partial paralysis is divided into hemi- 
plegia, when it is limited to one side of the body, and -para- 
plegia, when it is confined to the lower half of the body. 

The term local paralysis is used when only a small portion 
of the body is afflicted, as the face, a limb, a foot, &c. 

There are certain forms of paralysis which arise from the 
use of metallic poisons, as mercurial palsy and lead palsy. 
There is also a peculiar affection known as paralysis agitans, 
or shaking palsy. 

GENERAL PARALYSIS. 

General paralysis — or complete loss of sensation and mo- 
tion of the whole system — cannot take place without death 
immediately resulting ; but this term is usually applied to 
palsy affecting both hands and feet, whether any other parts 
of the body are implicated or not. 

HEMIPLEGIA. 

By the term hemiplegia is understood paralysis of one side, 
extending generally to both the upper and lower extremities. 



PARALYSIS. 61 

It is the most common form of palsy ; the left suffers more 
than the right side. When only one extremity suffers it is 
generally the arm. The paralysis usually extends to the side 
of the face, the angle of the mouth being drawn slightly 
upwards and to the sound side. The tongue, also, is often 
affected ; when protruded, its point is turned towards the 
palsied side. The paralysis is always limited to one half of 
the body, the median line being the boundary. In most 
cases the sense of feeling as well as motion is lost. The 
mental faculties are sometimes uninjured, but more frequent- 
ly are irreparably damaged. The memory especially becomes 
affected ; at the same time there is a peculiar tendency to 
shed tears, and to be much affected by slight causes. 

If recovery takes place, the symptoms of amendment are 
first noticed in the leg. In hopeless cases the limbs waste ; 
and they are colder, and unable to resist the influence of 
cold or heat equally with the sound parts. Hemiplegia is 
generally the result of organic injuries of the brain. It is 
often a sequel of apoplexy, and in such cases the effused 
blood is found on the side of the brain opposite to the affect- 
ed half of the body. 

PARAPLEGIA. 

By the term paraplegia is meant paralysis of the lower 
half of the body. It generally comes on slowly and insidi- 
ously, with weakness and numbness of the feet and legs, or 
with tingling of these parts, unattended by pain. By de- 
grees the weakness increases until there is complete loss of 
sensibility and motion in the lower extremities, with paraly- 
sis of the bladder and rectum. Although voluntary motion 
is completely abolished in the lower limbs, involuntary move- 
ments and spasms of the muscles are not uncommon. Para- 
plegia may arise from injury of the spinal cord or its mem- 
branes ; from inflammation or other diseases of these parts ; 
from tumors pressing upon the cord ; as well as from affec- 
tions of the bones and cartilages of the spinal column. 



62 MEDICAL AND SURGICAL COMPANION. 



LOCAL PARALYSIS. 

Of the different varieties of local palsy, I will oiily men- 
tion paralysis of the face. As only one half of the face is 
affected, the appearance is very striking, the features on the 
paralyzed side being blank, unmeaning, and void of all ex- 
pression. It is generally free from danger, being but rarely 
connected with disease of the brain. Exposure to cold is said 
to be a frequent cause of it. 

MERCURIAL PALSY. 

Mercurial palsy, or mercurial tremor, as it is sometimes 
termed, consists of a kind of convulsive agitation of the 
voluntary muscles, which is increased when volition is 
brought to bear upon them. In advanced stage of the dis- 
ease, articulation, mastication, aud locomotion are per- 
formed with difficulty, while the use of the hands is almost 
entirely lost. The skin acquires a brown hue, aud the teeth 
turn black. Workmen exposed to the fumes of mercury., 
such as gilders of buttons, glass-platers, barometer-makers, 
&c, are very liable to it. 

LEAD PALSY. 

This affection usually follows or accompanies lead colic, 
though it may exist independently. The poison of lead 
appears to exert some peculiar noxious influence over the 
nerves of the forearm and hand ; in consequence of which 
the extensor muscles of the hands and fingers become para- 
lyzed, so that when the arms are stretched out the hands 
hang down by their own weight, or, as the patients say, the 
wrists drop. The lower extremities are very rarely affected. 
The sufferers frequently experience attacks of lead colic. 

A characteristic symptom of lead in the system is the 
existence of a blue or purplish line — the sulphuret of lead 
— round the edges of the gums, just where they join the 
teeth. numbers, painters, color-grinders, type-founders, 
&c, are the usual sufferers from this affection. 



PARALYSIS. 63 



PARALYSIS AGITANS. 



Paralysis agitans, or shaking palsy, is characterized by a 
tremulous agitation, — a continued shaking, — usually com- 
mencing in the hands and arms, or in the head, and gradu- 
ally extending over the whole body. The disease progresses 
slowly, but when far advanced the agitation is often so vio- 
lent as to prevent sleep ; the patient cannot carry food to his 
mouth ; swallowing and mastication are performed with 
difficulty ; the body is bent forward, and the chin bent on 
the breastbone ; the urine and feces pass involuntarily, and 
coma, with slight delirium, closes the scene. 

TREATMENT OF PARALYSIS. 

. As paralyisis is only the effect of some morbid disease or 
injury in the brain or spinal cord, our treatment must be 
directed to the diseased condition on which it depends. In 
hemiplegia, when seen early, benefit may be derived from 
active cathartics, such as two or three drops of Croton oil, 
made into a pill with a crumb of bread, or ten grains of 
calomel and fifteen of jalap. The Croton oil is to be pre- 
ferred, as it operates in much less time than calomel and 
jalap. Stimulating and purgative injections often prove 
beneficial. But in cases of hemiplegia and paraplegia, pa- 
tients should be placed under the care of a regular physician 
as soon as possible. 

In mercurial palsy the patient must be removed from the 
injurious atmosphere. Warm baths, good food, sea air, and 
iodide of potassium in five to ten grain doses in a gill of 
water, three times a day, will generally effect a cure. 

Lead Palsy. In the treatment of lead palsy, the follow- 
ing mixture will be found beueficial. 

Take of Iodide of Potassium, . . 8 scruples. 
Peppermint Water . . .4 ounces. 

Mix. One to two teaspoonfuls may be taken in a gill of 



64 MEDICAL AND SURGICAL COMPANION. 

water, three times a day. The iodide of potassium acts as a 
curative agent in lead poisoning, by converting the lead into 
a form (the iodide of lead) which can again be readily taken 
up by the blood, and evacuated by the natural outlets. 

In paralysis agitans, or shaking palsy, I know of no meas- 
ures likely to do much good. But the effects of pure air, 
nourishing diet, baths, preparations of iron, and occasional 
opiates, may be tried. 

EPILEPSY. 

Symptoms. A fit, in which the patient usually utters a 
loud shriek or scream, and immediately falls to the ground 
in a convulsion ; the eyes are distorted and turned up ; 
hands clinched ; limbs convulsed, foaming at the mouth, 
the whole ending in a deep sleep. 

Causes. The tendency to epilepsy is often hereditary. 
Sudden fright, anger, injuries to the nerves, &c, may pro- 
duce it. 

Treatment. During the fit, the patient should be laid in 
an easy position, his neckcloth, together with any tight 
parts of his dress, loosened. A piece of cork or soft wood 
should, if possible, be introduced between his teeth, to pre- 
vent injury to his tongue. The application of cold water to 
the head will sometimes be useful, especially if the counte- 
nance is turgid and congested. 

In the interval, give tonics, and endeavor to improve the 
patient's general health. Persons subject to frequent attacks, 
may find the following mixture beneficial. 

Take of Bromide of Potassium, . . £ ounce. 

Spearmint Water, . . .3 ounces. 

Mix. From half a teaspoonful to two teaspoonf'uls, in a 
wineglassful of water, may be taken three or four times a 
day. 



65 



HYSTERIA. 

This is a nervous disorder, often assuming the most varied 
forms, but commonly presenting a paroxysmal character. It 
chiefly affects females between the ages of fourteen and forty- 
five, and principally those possessing great susceptibility of 
the nervous system and of mental emotion. 

Symptoms. Convulsive movements of the trunk and 
limbs, violent beating of the breasts with the hands clinched, 
or tearing of the hair or of the garments, shrieks and 
screams, violent agitation, and the sensation of a ball rising 
upwards to the throat, frequently attended by a feeling of 
suffocation, the attack ending with tears, convulsive fits of 
crying or laughter, and sometimes with violent hiccup. Oc- 
casionally the patient sinks to the ground insensible and 
exhausted, remains so for a short time, and then recovers, 
tired and crying, The fit is often followed by the expulsion 
of a quantity of limpid urine ; occasionally it is passed invol- 
untarily during the paroxysm. In most cases the patient 
is aware of what is passing around her. 

Treatment. During the fit, the patient's dress should 
be loosened ; she should be prevented from injuring her- 
self; should be surrounded by cool air; and the following 
mixture given in teaspoonful doses : — 

Take of Fluid Extract of Valerian, . . 4 drachms. 

Tincture of Assafcetida, . . 4 drachms. 

Mix. Give a teaspoonful, and repeat in twenty minutes. 
Bathe the head with cold water. If the patient is not 
relieved within one hour, give thirty drops of laudanum, 
which will almost invariably end the fit in less than an 
hour. Hysterical women are generally troubled with some 
irregularity of I he menstrual function, and require some 
treatment to improve the general health. 
5 



MEDICAL AND SURGICAL COMPANION. 



FAINTING. 

Causes. Sudden and violent emotions of the mind, inju- 
ries, bleeding, debility, the warm foul air of crowded rooms, 
disease of the heart, &c. 

Treatment. Lay the person on his back, take off his 
cravat, open the doors and windows, or carry the patient 
into the open air, and sprinkle cold water in his face. 
Smelling salts may be held to the nose, and as soon as 
he revives so as to be able to swallow, give some spirit, 
as brandy or whiskey. 



CATALEPSY. 

This is a rare disease. Nervous hysterical women are 
most likely to suffer from it. By a fit of catalepsy is implied 
a sudden loss of consciousness and volition — the patient 
remaining, during the attack, in the same position in which 
she happens to be at the commencement, or in which she 
may he placed during its continuance. The attack may last 
only a few minutes, or several hours, or even one or two 
days. On recovery, which is generally instantaneous, there 
is no recollection of what has occurred. 

The treatment should be similar to that for hysteria. 
Avoid all lowering remedies. 



ST. VITUS' DANCE. {Chorea.) 

This disease is characterized by incomplete subserviency 
of the muscles of voluntary motion to the will, giving rise 
to irregular, tremulous, and often ludicrous actions. It 
occurs most frequently in young girls between the age of six 
and sixteen. 



CHRONIC RHEUMATISM. 67 

Symptoms. It generally begins with twitchings of the 
muscles of the face. By degrees all, or almost all the voluu 
tary muscles become affected ; the child finds it impossible 
to keep quiet ; there is a constant movement of the hands 
and arms, and even of the legs ; one side of the body is 
generally more affected than the other ; the features are 
curiously twisted and contorted, the speech is affected, and 
these movements are always most severe when the child is 
watched. During sleep these irregular actions usually 
cease. The disease is scarcely ever fatal, or even danger- 
ous, unless it merges into organic disease of the nervous 
centres, or into epilepsy. Although most common in girls, 
yet boys not unfrequently suffer from it. 

Causes, &c. This disease may last from one week to 
several months ; the average duration, in uncomplicated 
cases, under the use of tonics and good food, being about 
four weeks. It is often complicated with hysteria, and the 
general health is usually below the normal standard. Fright 
seems to be a frequent cause ; blows or falls seem some- 
times to have induced it ; and the occurrence of the disease 
from irregular teething, or from the irritation of intestinal 
worms, has long been noticed. Deranged uterine function 
is occasionally the apparent cause. 

Treatment. The bowels should be well regulated by 
giving appropriate cathartics. If worms are suspected, give 
the remedies recommended for them, for a reasonable time. 
A plenty of good food and fresh air are essential. Three to 
five drops of the tincture of chloride of iron, in half a wine- 
glassful of water, three times a day, will probably prove 
beneficial, if continued for some time. Recipe No. 57 
generally proves beneficial. 



68 MEDICAL AND SURGICAL COMPANION. 



LOCKED JAW. {Tetanus.) 

This is a disease characterized by long-continued, painful 
contraction or spasm of a certain number of the voluntary 
muscles. 

Symptoms. The muscles of the jaws and throat are usu- 
ally first affected. When the disease proceeds, the muscles 
of the trunk and extremities become implicated. The mus- 
cles of the back are sometimes so much affected that they 
bend the body into the shape of an arch, so that the patient 
rests upon his head and heels. The abdominal muscles, 
when much affected, may bend the body so that the head 
will nearly touch the feet. The muscles of the side may 
also be similarly affected. 

The suffering caused by the tetanic spasms is absolutely 
frightful to contemplate. 

Causes. Exposure to damp aud cold, bodily injuries or 
wounds, local irritation of a nerve, &c. 

Treatment. If it arise from a wound, or injuries done 
to nerves or tendinous parts, apply laudanum very freely 
to the wound, after which cover it with a warm poultice. 
Opening or enlarging the wound may do good in some 
cases, but laudanum freely applied to the seat of injury, 
aud also given internally, in large doses of from thirty to 
sixty drops, every three to six hours, according to the 
urgency of the symptoms, will probably do about as much 
good as any course of treatment. Etherizing the patient, 
and keeping him under the influence of that drug for many 
hours, is sometimes beneficial. At the commencement of 
this trouble the bowels should be moved by some cathartic, 
unless they are at the time quite free. If any nourishment 
is given, let it be milk or beef tea. This is a very serious 
and often fatal disease, and it will be well to call a physician 
as soon as possible. If one is not to be obtained, follow the 
above directions, and hope for a favorable result. 



HYDROPHOBIA. 69 



HYDROPHOBIA. 



This is a most fearful, painful, and fatal malady, arising 
from the bite of a rabid animal. It manifests itself after an 
uncertain interval, varying from one month to eighteen. 
The majority of cases present symptoms within thirty or 
forty days from the inoculation of the poison. 

Symptoms. A sense of chilliness, languor, and lassitude ; 
there is restlessness also, and some headache. Sometimes 
there is a sensation of numbness or soreness in the bitten 
part. In two or three days the confirmed stage of the 
disease commences with talkativeness, peculiar sighings, 
and a horror of liquids ; then succeeds a frequent sense of 
suffocation, an excessive secretion of saliva, and violent 
spasmodic convulsions of the whole body, occasioned espe- 
cially by the sight of liquids, or the sound of running water, 
or any attempt at drinking. The general duration of this 
disease is from two to three or four days. As the fatal 
issue approaches, the sense of suffocation becomes more 
urgent, the convulsions more violent, the saliva more diffi- 
cult to expel, though the attempts at spitting are incessant, 
and the terror greater, until at length wild delirium suc- 
ceeds, followed by exhaustion and death. 

There seems reason to believe that only a part of those 
bitten by rabid animals suffer from hydrophobia. 

Treatment. This must be preventive, for the cure of 
the disease seems, in the present state of medical knowledge, 
almost hopeless. For directions for treating bites of rabid 
animals, &c, see the article on " Poisoned Wounds," in the 
Surgical part of this work. 

In treating the disease" itself, I should resort to the inhala- 
lation of ether, or to large doses of laudanum or opium, to 
relieve the patient, but with little or no hope of curing the 
disease. 



70 MEDICAL AND SURGICAL COMPANION. 



NEURALGIA. 

Neuralgia consists of violent pain in the trunk or branch 
of a nerve, occurring in paroxysms, at regular or irregular 
intervals. It may attack the nerves of the head, face, trunk, 
or extremities ; the subcutaneous nerves of these parts suffer 
the most frequently. 

Causes. Predisposing. — The nervous temperament. 
Low state of the system. Delicate health. Exciting. — 
Irritation of the root of the nerve within the cranium. Re- 
mote organic disease, especially disease of the kidney. Irri- 
tation of decayed teeth, &c. 

Treatment. This must vary with the cause. If there 
is any source of local irritation, as a decayed tooth, it should 
be removed. If the general health is poor, improve it in 
every way possible : — by relaxation from business for a 
time, in cases where application has been too close ; by giv- 
ing some preparation of iron (R. 59), or epiinine (R. G3), in 
cases where there is much debility. During a paroxysm, 
to relieve the pain, apply liniment No. Ill, and take a dose 
of laudanum, or morphine if necessary. 

Persons subject to neuralgic attacks must endeavor to 
ascei'tain the cause or causes, and remove them ; otherwise 
pcrmaueut relief can hardly be expected. The digestive 
organs often need attention, and in women, the uterine func- 
tions should not be neglected. 



71 



CHAPTER Y. 

DISEASES OF THE AIR PASSAGES AND 
LUNGS. 

ACUTE CATARRH. A COLD. 

Acute Catarrh consists of inflammation of the mucous 
membrane of some part of the air passages. It is com- 
monly known as " a cold." If confined to the eyes and nos- 
trils, it is termed a cold in the head ; if it extends to the 
bronchial tubes, it is called bronchitis. It is the common- 
est of all diseases, and arises not from mere cold, but from 
too sudden a change of temperature, or from exposure to 
wet, &c. 

Symptoms. The symptoms chiefly consist of lassitude, 
pains in the limbs, aching of the back, a sense of tightness 
across the forehead, excessive discharge from the nostrils, 
profuse lachrymation, hoarseness, sore throat, furred tongue, 
more or less feverishness, thirst, loss of appetite, and a quick 
pulse. At the end of two or three days these symptoms be- 
gin to subside, or the disease passes into some more sevei-e 
affection, as acute bronchitis, lung fever, &c. 

Treatment. No one applies to a doctor to cure a cold. 
Every man acts as his own physician, and judiciously amuses 
himself with slops or herb teas, putting his feet in hot water, 
&c, while the disease runs its course, and in three or four 
days exhausts itself. Doubtless the cure may sometimes 
be hastened by a good purgative, followed by ten grains of 
Dover's powder ;it bedtime, or the use of R. 21 or R. 22. 
In some persons, an opiate at bedtime (ten to fifteen grains 
of Dover's powder) will cut short a catarrh or " cold." 



72 MEDICAL AND SURGICAL COMPANION. 



CHRONIC CATARRH, &c. 

Attacks of acute catarrh are apt to recur, ou slight causes, 
in many susceptible subjects, and occasionally it becomes 
chronic in persons whose systems are not strong ; and when 
it has become so, it is increased by the supervention of a 
fresh attack of the acute form of the disease ; and if these 
recurrences are frequent, serious impediments will be offered 
to a termination of tbe affection. 

Symptoms. Persons who apply for the purpose of being 
treated for what they term catarrh, complain of more or less 
discharge from the nostrils, also of a " dropping down " of 
matter from the posterior nasal passages into the throat ; and 
there is in many cases an unnatural and more or less pro- 
fuse secretion from the mucous membrane of the throat, 
which obliges the patient to hawk and spit frequently. The 
tonsils are often in an unhealthy and sometimes enlarged 
condition, and the uvula is frequently elongated to such an 
extent that its point lays upon the back part of the tongue, 
causing a tickling seusation to be experienced there, often 
accompanied by a desire to swallow. In some cases the 
patient is troubled with slight cough, and the disease is 
threatening to extend downwards into the larynx, trachea, 
bronchial tubes, &c, which it may do, sooner or later, if 
allowed to go on unchecked. 

This disease is very common in our climate, and probably 
ever will be, and it is a source of great annoyance and dis- 
comfort to those who are afflicted with it. 

Treatment. Chronic catarrh, affecting the mucous mem- 
brane of the nasal passages and throat, is often a very ob- 
stinate disease to treat ; but many cases can be cured, and 
all greatly relieved or checked by appropriate general and 
local medication. 

Persons afflicted with this trouble are continually trying 
" catarrh snuffs," and other quack preparations, one after 



CHRONIC CATARRH. 73 

another, obtaining but little if any relief, until at length, 
after the disease has been upon them for a long time, and 
has become almost intolerable, they are led to apply to a 
physician for treatment. 

Various are the means and measures used in the treatment 
of catarrh of the throat and nasal passages. Astringent 
gargles, inhalations of medicated vapors, and atomized li- 
quids, &c, are found to be useful in nearly all cases. The 
nasal douche, by which a stream of medicated water passed 
into one nostril escapes from the other, is also very ben- 
eficial, when properly managed. 

If, when applied to for treatment in these cases, the uvula 
is very much elongated, I remove a portion of it ; and if the 
tonsils are so much enlarged as to impede respiration, their 
removal is also recommended. Then I proceed to make such 
applications to the throat and nasal passages as experience 
has taught me are most beneficial and effective in restoring 
the mucous membrane to a healthy. condition. Solutions of 
the crystals of nitrate of silver, varying in strength from 
twenty to eighty grains to an ounce of water, when applied 
to the parts by means of a " shower syringe" which I have 
made for this purpose, will, I believe, do more good, in the 
majority of cases, than any other course of treatment. The 
strength of the solution should vary according to the condi- 
tion of the parts. It is not often necessary to use one 
stronger than forty grains to the ounce. The application 
should be made, in some cases, every day, for a week or 
more ; then every second, third, or fourth day, until the mu- 
cous membrane begins to have a natural or healthy look. 
While making these applications, the general health of the 
patient requires attention. If he is scrofulous, or has any 
poison lurking in his system, tonics and alteratives will be 
required. Treatment should be persevered in for several 
months if necessary. 



74 MEDICAL AND SURGICAL COMPANION. 



CLERGYMAN'S SORE THROAT. 

This disease, in its early stages, consists of irritation of 
the investing membrane of the fauces. Subsequently a 
series of morbid changes takes place, such as congestion, 
inflammation, or relaxation of the mucous membrane, en- 
largement of the tonsils, elongation of the uvula, and irrita- 
tion, inflammation, morbid deposit, and ulceration of the 
mucous follicles. This sore throat either exists alone, or it 
may accompany or follow laryngitis, bronchitis, or consump- 
tion. Clergymen, lawyers, public speakers, actors, singers, 
&c, are most liable to it. 

Symptoms. These consist of an uneasy sensation in the 
upper part of the throat, with continued inclination to swal- 
low. The patient also makes frequent attempts to clear the 
throat by coughing, hawking, and spitting ; he will point to 
the larynx, too, as being the seat of pain. At the same 
time the voice undergoes an alteration ; there is loss of 
power and hoarseness ; sometimes complete loss of voice, 
especially towards the evening. On examining the throat 
and fauces, we shall find these parts presenting an unhealthy, 
slightly raw or granular appearance ; the mucous follicles 
will be visible, sometimes filled with a yellowish substance, 
and a viscid muco-puruleut secretion will be seen adhering 
to the palate. 

Treatment. In the early stages, the treatment must con- 
sist in the use of tonics, especially iron and quinine, the 
cold bath, or sea-bathing, and temporary change of scene 
and occupation. 

"When the disease is further advanced, a combination 
of internal with local remedies will be necessary. Iodide 
of potassium (R. 67) or iodide of iron (R. 68) may prove 
beneficial. The local treatment consists in the application 
of a solution of nitrate of silver (one to four scruples to the 
ounce of distilled water) to the diseased parts, even to the 



ACUTE INFLAMMATION OF THE LARYNX. 75 

interior of the larynx if possible, by means of the shower 
syringe, or probang. The operation requires dexterity, and 
can only be properly done by a physician. The application 
will require to be made about every second day for two or 
three weeks. When the tonsils are much enlarged, they 
will need attention ; and if the uvula is considerably elon- 
gated, it may require excision. 



ACUTE INFLAMMATION OF THE LARYNX. 

{Laryngitis.} 

This is not a very common disease, but in the greater 
proportion of cases in which it has occurred in a very 
severe form, it has proved fatal. Cold and wet are com- 
monly the exciting causes of it, and, generally speaking, it 
is peculiar to adults. "Washington is supposed to have 
died of it. 

Symptoms. The symptoms of acute inflammation of the 
larynx are often at first obscure, as the disease may make 
its approach in a very insidious manner. Generally, how- 
ever, they are these : Fever, harsh cough, pain referred to 
the Pomum Adami, difficulty of breathing and of swallow- 
ing, excessive anxiety, hoarseness, or even complete loss of 
voice, and frequent spasmodic exacerbation of these symp- 
toms, causing the most distressing paroxysms of threatened 
suffocation. The inspirations are long, and attended with a 
peculiar wheezing sound, as if the air were drawn through 
a narrow reed. The face is flushed, the eyes protruded, the 
lips swollen, and the pulse hard. Unless relief be afforded, 
the distress gets greater and greater, the larynx and trachea 
move with great rapidity upwards and downwards, the chest 
heaves violently, the patient tries to get to the open window 
to obtain more air ; he soon becomes drowsy and delirious, 
and then speedily dies, suffocated. 

The inflammation is often of very limited extent : the 
danger is owing entirely to its situation. 



76 MEDICAL AND SURGICAL COMPANION. 

Treatment. In some mild cases, seen early, an emetic, 
composed of the following articles, will prove benefic.al : - 

Take of Wine of Ipecac, . • • U ounces ' 

Tincture of Lobelia, • \ ounce * 

Mix. Give a tablespoonful in half a cupful of warm 
water every fifteen minutes, until free vomiting takes place. 
Keeping the patient slightly nauseated for several hours by 
giving, every hour or two, from half a teaspoonful to a tea- 
spoonful of the mixture, will generally prove beneficial. 
The bowels should be moved by a good dose of Epsom salts 
as early after the operation of the emetic as convenient; but 
the nausea must first be allowed to subside. In some cases, 
especially where the bowels are somewhat constipated, it 
may be advisable to give the purgative first. A hot flaxseed 
poultice may be placed upon the throat, and during the 
whole treatment the patient should avoid using his voice 
altogether, or speak only in a whisper, and should suppress 
the cough as much as possible. Rest and low diet are also 

requisite. 

Iu severe cases the above measures will prove of little 
avail. Something more prompt and decisive must be done 
at once, or the patient may be dead in a few hours. With 
a probang, sponge the epiglottis, larynx, and cavity of the 
larynx, with a solution of the crystals of nitrate of silver, 
sixty to eighty grains to the ounce of water. It will gen- 
erally give marked relief within twenty minutes. Repeat. 
the operation in two or three hours if necessary. Let the 
patient hold small pieces of ice in the back part of Ins throat 
continually, and very hot fomentations should be applied to 
the throat externally for a considerable length of tune. 

After the urgent symptoms have subsided, the treatment 
applicable to milder cases will complete the cure. 

But if this treatment fails to give relief, a surgeon should 
be called at once, who will proceed to open the windpipe, 
which may save the patient. 



MEMBRANOUS CROUP. 77 

Chronic Laryngitis, &c. The larynx may also suffer 
from chronic disease. Thus chronic inflammation and ul- 
ceration is not uncommon in cases of pulmonary consump- 
tion, and the lining membrane of the laryngeal cartilages 
often becomes thickened and ulcerated in secondary syphilis. 
"Warty growths may also arise from different parts of this 
tube, and cause great impediment to the entrance and exit 
of air. These cases always require the attention of a 
physician. 

MEMBRANOUS CROUP. (Tracheitis.) 

This disease consists of inflammation of the trachea 
(windpipe), often of the trachea and larynx, ending, in 
the majority of cases, in the exudation of false membranes 
upon the affected surface. It is a disease of early life, most 
cases occurring between the second and fourth year of child- 
hood. It is sometimes complicated with pneumonia (lung 
fever) or bronchitis. 

Symptoms. In the commencement they are those of a 
cold ; slight fever, cough, hoarseness, drowsiness, suffusion 
of the eyes, and running at the nose. In a day or two there 
is an alteration in the character of the cough, which be- 
comes attended with a peculiar ringing sound, rendering it 
" brassy," this cough being followed in a few .hours by a 
remarkable change in the respiration. The act of inspira- 
tion becomes prolonged, and attended with a characteristic 
crowing or piping noise, readily recognized when once it has 
been heard. If now the throat be examined, the tonsils 
will be found enlarged and of a red color ; the uvula also 
is sometimes slightly swollen. As the disease advances the 
fever increases, the breathing becomes more hurried and 
impeded, the cough more frequent, the pulse becomes weak 
and irregular ; there is great thirst, and the child is very 
irritable and restless, and, with features expressive of alarm 
and distress, he grasps at his neck, or thrusts his lingers 



78 MEDICAL AND SURGICAL COMPANION. 

into his mouth, as if to remove the cause of his suffering. 
The child appears brighter in the morning than at night. 
Should there now be a tendency towards restoration to health, 
the cough will lose its peculiar clang, aud become moist, 
whilst the crowing inspirations will almost cease. On the 
other hand, when the disease is about to cud fatally, the 
drowsiness soon becomes extreme, though the sleep is un- 
easy ; the child starts and wakes in terror, the skin gets 
cold aud covered with clammy sweats, and the child often 
dies directly after an inspiration, or coma aud convulsions 
close the scene. 

Sometimes the disease runs a very rapid course, the child 
dying in less than twenty-four hours, though its usual dura- 
tion ranges from four to ten days. Fully one half of those 
attacked die. 

Treatment. In no disease, perhaps, is it more necessary 
to be prompt and cautious. In all cases the patient must be 
confined to bed, aud should be clothed in flannel. The air 
of the room should be kept warm and moist. When the 
disease is seen early, the continuous application of very hot 
fomentations to the throat will do great good. But if much 
benefit be not quickly apparent, an emetic should be given, 
and the following will, perhaps, be as good as any : — 

Take of.Wmc of Ipecac, . . l£ ounces. 

Tincture of Lobelia, . . £ ounce. 

Mix. For a child from one to three years old, give from 
half a teaspoonful to a teaspoonful, every ten minutes, until 
free vomiting takes place. Also give a warm bath. Sup- 
posing that the disease advances, notwithstanding these meas- 
ures, send for a physician, if one is to be obtained ; for 
opening the windpipe (tracheotomy) may possibly save the 
child. Some physicians recommend sponging the larynx 
with a strong solution of nitrate of silver, as directed in 
acute laryngitis in adults, and I believe it should be tried 



DIPHTHERIA. 79 

when other measures fail to give relief; but as the false 
membrane often extends down the windpipe, and even into 
the bronchial tubes, it is not probable that in such cases 
much benefit would be derived from it. 



SPASMODIC CROUP. {Laryngismus Stridulus.) 

This affection occurs in children. A child is suddenly 
attacked during the night, having, perhaps, gone to bed ap- 
parently in perfect health. The breathing is labored and 
sonorous, the cough presents, in a marked degree, the shrill, 
ringing, crouped character. This causes great alarm, and 
the physician is sent for in urgent haste. This is a purely 
spasmodic affection, and, as a general rule, unattended with 
danger. 

Treatment. Give an emetic of ipecac at once, and, 
after its operation, the bowels should be moved by some 
mild cathartic. A hot foot bath, and warm fomentations to 
the throat, may prove beneficial. 



DIPHTHERIA. 

Diphtheria may be defined as an epidemic sore throat, due 
to poisoning of the blood. It is attended with much pros- 
tration, and is characterized by the exudation of false mem- 
branes on the tonsils and adjacent parts. It runs a rapid 
course. When it does not end fatally, it is often followed by 
an alteration in the voice, partial paralysis of the muscles 
of deglutition, weakness of the upper extremities, and im- 
paired vision. It is regarded as a contagious disease. It 
attacks both sexes, at all ages, though children seem to be 
especially obnoxious to it. It is most fatal to such as reside 
in damp situations and in badly-drained houses. Spring and 
autumn appear to be the seasous when its ravages are 
greatest. 



80 MEDICAL AND SURGICAL COMPANION. 

Symptoms. This disease comes on very gradually, with 
feelings of depression and muscular debility, headache, 
nausea, slight diarrhoea, chilliness, and drowsiness. Before 
the throat is actually sore, a sense of stiffness in the neck is 
complained of. Soon the tonsils become inflamed and swol- 
len, and the glands about the angles of the lower jaw get 
tender. As the disease progresses, the whole throat becomes 
more or less involved, and there are some pain and difficulty 
in swallowing in most cases. 

It is probable that in some mild cases the inflammation 
begins to subside at this stage, and the patient is soon re- 
stored to health. But more commonly the characteristic fea- 
ture of the disease now becomes manifested, and a plastic 
fibrinous material is effused. This exudation commences on 
the soft palate, or on one tonsil, or on the back of the 
throat, in the form of small ash-colored specks ; these spots 
enlarge and run together, forming patches of considerable 
size; As the disease spreads, the false membrane increases 
iu thickness and in extent ; it usually becomes firmly at- 
tached to the mucous tissue beneath, and if it be forcibly 
removed, a new patch will be found at the end of a few 
hours. But if the exudation be cast off naturally, then 
either no new false membrane is formed, or only one which 
is much more filmy than the first. The membrane has been 
compared to wet parchment, or to damp, dirty wash-leather. 
It may spread forwards to the cheeks and gums, upwards 
into the nasal passages, downwards into the windpipe and 
oesophagus. When the membrane begins to separate and 
decompose, the patient's breath is rendered most offensive. 
As the lymphy deposit is cast off, we may have ulceration, 
sloughing, or gangrene of the mucous coat, or this tissue 
may gradually assume a healthy appearance. 

In all cases, this is a very grave disease. Death may 
occur, even within thirty-six hours, from the intensity of the 
general disorder, or at a later period from the severity of 
its local effects, or from the occurrence of some complication. 



DIPHTHERIA. 81 

The duration of the disease may be stated as commonly 
from three to twelve days. 

Treatment. This disease is not controllable by any 
known specific remedy. The great object of treatment is 
to support the system, endeavoring to keep the patient alive 
until the disease has run its course. The complaint being 
one characterized by great prostration, the diet should con- 
sist of milk, beef tea, or essence of beef. Stimulants are 
also called for, and an adult may take, in severe cases, an 
ounce or two of brandy or whiskey every hour or two. For 
youth and children, the dose should be in proportion to age. 
The tincture of the chloride of iron, either with or without 
quinine, should also be given. The following is an excellent 
preparation : — 

Take of Sulphate of Quinine, . .16 grains. 
Tincture of Chloride of Iron, £ ounce. 

Water, 7£ ounces. 

Mix. An adult may take a tablespoonful in a wineglass- 
ful of water, four times a day. A youth of fourteen years, 
one half tablespoonful ; a child two to six years of age, from 
one half teaspoonful to a teaspoonfnl. Two drachms of 
chlorate of potassa may be dissolved in a pint of water, and 
used freely as a gargle. Small pieces of ice or snow may be 
continually held in the mouth, if the effect be agreeable. 
The tincture of chloride of iron, applied to the throat by 
means of a camel's-hair brush, several times in the twenty- 
four hours, generally proves beneficial in checking the exu- 
dation of false membrane. 

This being a very serious disease, a physician, if one is 
to be obtained, should be early called to take charge of 
the case. 

6 



82 MEDICAL AND SURGICAL COMPANION. 



INFLUENZA. 

Influenza, or epidemic catarrhal fever, is a disorder attend- 
ed with great depression, chilliness, running from the eyes and 
nose, frontal headache, cough, restlessness, and fever. It 
arises at various periods from some peculiar condition or 
contamination of the atmosphere. The poisonous influ- 
ence, whatever its nature may be, wings its way with greater 
celerity than the speed of human intercourse, while its prog- 
ress seems uninfluenced by the season of the year. It is 
said to travel from east to west, and it seldom remains in 
one district more than six or eight weeks. Some visitations 
are more severe than others. It differs from a common 
cold in its greater severity, and especially in the amount of 
prostration to which it gives rise. Between the reception 
of the poison and the commencement of the symptoms, 
there is a period of incubation ; but as to the duration of 
this we know nothing, since, in some well-observed ci 
has appeared to be only ten or twelve hours, while in other 
instances it has been as many days. Young people seldom 
die of this disease ; but amongst the aged the mortality lias 
sometimes been large. 

Symptoms. The chief symptoms of this mysterious affec- 
tion are heat and dryness of skin, urgent frontal headache, 
soreness or tenderness of throat, hoarseness, harassing cough, 
shortness of breath, and disorders of the stomach, together 
with all the signs of nervous and muscular prostration, 
such as an uncommon degree of languor, debility, and low- 
ness of spirits. 

In favorable cases, this disease runs its course in about a 
week, leaving the patient very much debilitated. 

Treatment. The patient should be kept in bed, and bar- 
ley water and nourishing broths administered. 

The following mixture may be given with benefit : — 



WHOOPING COUGH. 83 

Take of Syrup of Squills, ... 1 ouuce. 

Syrup of Gum Arabic, . . 1 ounce. 

Sweet Spirits of Nitre, . . 1 ounce. 

Paregoric, .... 1 ounce. 

Mix. One to two teaspoonfuls may be given three or four 
times in twenty-four hours. 

If the bowels are constipated, a mild cathartic may be 
given. A mustard poultice to the chest, and the inhalation 
of the steam of hot water, may prove beneficial in severe 
cases. 

When prostration is the predominant symptom, stimulants, 
such as wine or brandy, may be freely resorted to. 

The subsequent debility will be the quickest removed by 
tonics, especially by quinine and iron. 



WHOOPING COUGH. (Pertussis.) 

Wl looping cough is a contagious and infectious malady, 
characterized by a peculiar cough, occurring in paroxysms, 
terminated by vomiting. The disease makes its appearance 
in about a week after exposure. It occurs mostly in chil- 
dren, although adults are not wholly exempt from it. It 
rarely attacks the same person twice. 

SYMPTOMS. The disease generally sets in with the symp- 
toms of a common cold, and it is not till the second or third 
week after the attack, and when the fever symptoms have 
somewhat abated, that it assumes its peculiar and character- 
istic paroxysmal form and whoop. The cough now comes 
on in distinct fits, each fit consisting in a series of violent 
and convulsive expirations, with congestion of the face, and 
threatening of instant suffocation, followed by a sudden and 
lull inspiration, accompanied by a peculiar whoop, from 
which the disease has obtained its name. The convulsive 
coughing is renewed, and continues in the same manner as 



84 MEDICAL AND SURGICAL COMPANION. 

before, till a quantity of mucus is thrown up from the 
lungs, or the contents of the stomach are evacuated by 
vomiting, or the fluid issues from the mouth and nostrils, 
mixed with blood, which usually terminates the fit. The 
patient then generally has an interval of perfect freedom 
from cough, and often expresses a desire for food ; but 
when the fit has been very severe, it is followed by general 
languor and debility, hurried breathing, &c. The disease 
is usually most severe ahout the latter part of the fourth, 
or during the fifth week, after which the paroxysms become 
less severe. The frequency with which the paroxysms of 
cough recur, varies : there may be only two or three in a 
day, or as many in an hour. The duration of the disease 
varies, in different cases, from two or three weeks to three 
or four months. It frequently proves fatal when occurring 
iu quite young children. 

Treatment. In mild cases very little management is 
required ; the patient should be warmly clothed, kept in 
doors, and fed with light nourishing food. In the more se- 
vere form of the disease, an emetic may prove beneficial, 
and the wine of ipecac will be as good as any ; it may be 
given in teaspoonful doses, every ten minutes, until vomiting 
takes place. Mixture No. 28, given in one to two teaspoon- 
ful doses, three to five times a day, will be found beneficial 
in most cases. 

The following mixture may be tried in cases which prove 
obstinate : — 

Take of Sulphate of Zinc, . . .32 grains. 

Extract of Belladonna, . . 8 grains. 

Water, ..... 4 ounces. 

Mix. A child three years old may take a teaspoonful, in 
a little water, four times a day. Every second day, the dose 
may be slightly increased, so that at the end of two weeks, 
two or three teaspoonfuls may be given at a time. The 
child's bowels should not be allowed to become constipated, 



BRONCHITIS. 85 

and care must be taken to prevent it from taking cold, lest 
bronchitis or luna; fever set in. 



BRONCHITIS. 

By bronchitis, is meant an inflammation of the bronchial 
tubes. It may be either acute or chronic. 

ACUTE BRONCHITIS. 

This is a common disease, and occasionally proves serious 
in consequence of the inflammatory action spreading to the 
vesicular texture of the lungs. 

Syjiiptoms. Fever, a sense of tightness or constriction 
about the chest, hurried breathing, with wheezing, severe 
cough and expectoration, at first of a viscid, glaring mucus, 
which subsequently becomes purulent. The pulse is fre- 
quent, and often weak, the tongue foul, and there is head- 
ache, lassitude, sickness, and great anxiety. 

By placing the ear to the chest, we may now hear dry, 
wheezing or whistling sounds, and after a time the sounds 
change in character in conseqnence of the inflamed mucous 
membrane pouring out a viscid, transparent, tenacious mu- 
cus. As the air passes through this mucus, we hear a 
moist, crepitating sound. 

In favorable cases, this aflection begins to decline between 
the fourth and eight day, and shortly either entirely subsides, 
or passes into the chronic form. 

In severe or unfavorable cases, the disease may assume a 
more dangerous character ; the strength becomes much re- 
duced, signs of congestion of the lungs ensue, which may 
soon end in death. 

Treatment. Give a thorough purgative, after which the 
following mixture may be taken with benefit : — 



86 MEDICAL AND SURGICAL COMPANION. 

Take of Spirit of Miudererus, . . -J ounce. 

Sweet Spirit of Nitre, . . £ ounce. 

Syrup of Squills, . . . £ ounce. 

S) r rup of Ipecac, . . .2 drachms. 

Paregoric, . . . 2 drachms. 

Mix. One to two teaspoonfuls may he given to an adult, 
three or four times a day. 

If there be much debility, mixture No. 2-4 may be given 
instead of the above. 

• A mustard poultice applied to the chest occasionally, and 
kept on each time as long as it can be conveniently borne, 
will prove beneficial. It may be followed by hot fomenta- 
tions. 

Light food should be given if the fever runs high, but 
when there is depression, good beef tea may be freely taken. 
The inhalation of the steam of hot water often prm 
viceable. 

CHRONIC BEOHCHITIS. 

This disease is generally the sequel of the acute form, and 
is very common in middle and advanced life. 

Symptoms. The slighter forms are indicated only by 
habitual cough, some shortness of breath, and copious ex- 
pectoration. During the summer little trouble is expe- 
rienced from it, but it returns with cold weather, and lasts 
through the winter. After a time, when the patient's gen- 
eral health has become very much reduced, the cough con- 
tinues even through the summer, aud unless some effectual 
treatment is resorted to, the patient finally wears out, or 
dies of bronchial consumption. 

Severe examples of chronic bronchitis, with abundant ex- 
pectoration, are often taken by quad: consumption curers, for 
cases of pulmonary consumption, and they then vaunt 
their very ordinary cures as extraordinary. 



ASTHMA. 87 

Treatment. This is a disease in which the inhalations 
of medicated vapors and atomized liquids prove very bene- 
ficial ; but the limits of this work will not allow me to speak 
of all the preparations which may be used to advantage in 
this disease. R. 29 will prove excellent in many cases. 
The vapor of tar often proves serviceable. 

Stimulating expectorants are also useful ; and R. 24 may 
be taken with benefit in most cases. 

If the patient is debilitated, iron, quinine, and cod-liver, 
oil may be used to advantage. 

The patient should dress warmly, and wear flannel next 
the skin, both winter and summer. 



ASTHMA. 

Asthma may be defined as great difficulty of breathing, 
accompanied with a wheezing sound of respiration, occurring 
in paroxysms, and ceasing at the end of a few hours, with 
mucus expectoration, more or less abundant. 

Symptoms. A fit of the asthma often occurs suddenly, 
without any warning ; but in some cases it is preceded by 
headache and sleepiness, or by various digestive or other 
disturbances. The patient awakes towards morniug with a 
sensation of suffocation or constriction about the chest, the 
difliculty of breathing gradually increasing until a fearful 
and most painful struggle for breath sets in. Various pos- 
tures are assumed to facilitate the attempt at filling the 
luDgs, and the patient often rushes to the open window, at 
which he will remain a long time, gasping for air. If the 
ear is now placed to the chest, we hear loud wheezing or 
shrill whistlings. The pulse is small and feeble, the eyes 
Btaring, and the countenance anxious. After a certain lapse 
of time, a remission comes. Cough ensues, with expectora- 
tion of little pellets of mucus, and soon the paroxysm ceases, 
to allow the sufferer to full asleep. 



88 MEDICAL AND SURGICAL COMPANION. 

During the interval which elapses between one asthmatic 
paroxysm and the next, the patient often enjoys fair health, 
and has his breathing quiet and free. 

This disease is more common in men than in women. 
It is often hereditary, and it sets in at any time of life, 
though most frequently about the middle period. It may be 
uncomplicated ; that is to say, the patient is healthy in all 
other respects, there being no lesion of the brain, lungs, 
heart, or other organs. This form is known as spasmodic 
asthma. In other cases it is complicated with, or indeed 
symptomatic of, some disorder, such as chronic bronchitis, 
heart disease, &c. When thus complicated or symptomatic, 
it is known as symptomatic, or organic asthma. Spasmodic 
asthma very seldom, if ever, directly destroys life. Many 
of its subjects live to a good old age, perhaps for the reason 
that they are obliged to take good care of themselves. 

Treatment. Under this head must be considered the 
measures necessary to relieve the paroxysm, and those which 
may be employed in the hope of preventing or delaying its 
recurrence. The following emetic, given at the commence- 
ment of the attack, will be beneficial : — 

Take of Wine of Ipecac, ... 1 ounce. 

Tincture of Lobelia, . . £ ounce. 

Mix. Two teaspoonfuls may be given in a little warm 
water, every fifteen minutes, until vomiting takes place. 
After the operation of the emetic, if the bowels are consti- 
pated, a purgative may be administered. The inhalation of 
mixture No. 30 will generally prove very beneficial. 

Mustard poultices, applied to the back and front of the 
chest, seem occasionally to give relief. The inhalation of 
sulphuric ether will sometimes put an end to the paroxysm 
very speedily. Smoking stramonium leaves often does good. 
A warm climate is generally very beneficial to sufferers from 
this affection. 



HAY ASTHMA 89 

After the paroxysm has ceased, the general health of the 
patient should receive attention, with a view to prevent a 
recurrence of the trouble. It is always advisable, in these 
cases, to consult some good physician. 

HAY ASTHMA. 

This is a peculiar disease, which resembles a severe cold, 
to which asthmatic symptoms are frequently superadded. 

Symptoms. There is headache, suffusion of the eyes, 
sneezing, irritation of the nose and throat, with a dry, ha- 
rassing cough. Then at intervals there may be paroxysmal 
attacks of asthma, the difficulty of breathing being some- 
times so urgent that the patient has the most distressing 
sensations of impending suffocation. This is not a common 
disorder. 

Causes. It is supposed to arise from the inhalation of 
the aroma of spring grass or hay, or from the perfume of 
the Nardus Striata when in flower, — a grass which is 
abundant in many grazing fields, for cattle will not eat it. 

Exposure to the emanations of 'powdered ipecac will pro- 
duce it in impressible individuals. 

Treatment. The disease will probably have a duration 
of three or four weeks, if allowed to run its course without 
medical treatment, It may, however, usually be cut short 
by removal from the cause, sometimes residence at the sea- 
side being effectual. In some cases the susceptibility to the 
disease has been destroyed by the use of certain drugs — 
iron, quinine, arsenic, and nux vomica. 

During the paroxysm, inhaling R. 30 will generally give 
relief. Smoking tobacco is said to prove very beneficial for 
moderating the attack. Stramonium leaves may answer as 
well. 



90 MEDICAL AND SURGICAL COMPANION. 



PLEURISY. (Pleuritis.) 

By the term pleurisy, is meant inflammation of the pleura, 
which is the serous membrane investing the lungs, and 
lining the cavity of the chest. 

Symptoms. Chills, followed by fever, and an acute lanci- 
nating pain in the side, called a " stitch." The pain is in- 
creased by the expansion of the lung in breathing, by 
coughing, by lying on the affected side, and by pressure. 
There is also a short, harsh cough, the skin is hot and dry, 
the cheeks flushed, the pulse hard and quick, and the urine 
is scanty and high-colored. If the ear be placed to the pain- 
ful part of the chest, at this stage of the disease, we may 
hear the dry, inflamed membranes rubbing against each 
other, and producing a friction sound ; if the hand be placed 
on the corresponding part of the chest this rubbing may 
also be felt. But this sound does not long continue ; either 
the inflammation subsidesj and the two surfaces of the pleura 
regain their natural moisture and smoothness, or the rough- 
ened and inflamed surfaces become adherent ; or they be- 
come separated by the effusion of a serous or watery fluid, 
and a kind of dropsy results, known as hydrothorax, or 
water in the chest. If the pleurisy has been severe, the effu- 
sion becomes excessive, and the fluid accumulating in the 
sac of the pleura, compresses the yielding lung, suspends its 
functions, displaces the heart, and somewhat distends the 
sides of the chest. From one ounce to several pints of fluid 
may be effused. "When the amount is great, there is much 
difficulty of breathing ; and on gently tapping the diseased 
side with the ends of the fingers, we get a dull sound, very 
unlike that obtained from the well side, by the same process. 
At the same time, also, the sufferer is unable any longer to 
lay on the sound side, clearly because the movements of 
the healthy lung would be impeded by the superincumbent 
weight of the dropsical pleura. If the two sides of the chest 



PLEURISY. 91 

are measured, the side containing the effusion will be found 
the larger. 

Causes. The most common cause of pleurisy is exposure 
to cold and wet. Mechanical injuries will also excite in- 
flammation of the pleura. Thus the jagged ends of a frac- 
tured rib often give rise to it. 

Treatment. We must first subdue the inflammation ; 
and, secondly, promote the removal of its products. If the 
patient is very robust and plethoric, the fever high and pain 
severe, bleeding will give relief quicker than any other meas- 
ure which can be employed. From half a pint to a pint of 
blood may be taken from a vein at the bend of the elbow ; 
or six to twelve leeches may be applied about the seat of 
pain. In most cases I should use the leeches, and encourage 
bleeding from the bites for some time, by warm fomenta- 
tions. When the pain is not very severe, instead of bleed- 
ing, a mustard poultice may be applied to the diseased side, 
and allowed to remain on as long as the patient can conveni- 
ently bear it, after which hot fomentations should be con- 
tinually applied until relief is obtained. 

The bowels must be moved by a smart purgative, which 
may be repeated, if necessary, every second or third day ; 
the diet should consist of gruel, arrowroot, and broths ; and 
cooling drinks are to be allowed. To relieve severe pain, 
give Dover's powder, in ten to fifteen grain doses, two or 
three times a day, if necessary. 

If the fever is high, and the pulse quick and hard, the fol- 
lowing mixture may prove beneficial : — 

Take of Tincture of American Hellebore, 1£ drachms. 
Sweet Spirit of Nitre, . . 6£ drachms. 

Syrup of Gum Arabic, . . 1 ounce. 

Mix. Shake before using. A teaspoonful may be given, 
in a little water, every third hour, to reduce the frequency 
of the pulse. Its effect must be closely watched, and if it 
causes vomiting, or much prostration, it should be discontiu- 



92 MEDICAL AND SURGICAL COMPANION. 

ued, and half a teaspoonful of sweet spirit of nitre, three or 
four times a day, substituted for it. If these measures prove 
insufficient, and effusion takes place, we then endeavor to 
promote absorption. 

The patient must be kept on a moderate diet, free from 
stimulants, and purgatives and diuretics administered. A 
succession of blisters to the side may do good. 

The following mixture will often prove serviceable : — 

Take of Iodide of Potassium, . . 4 scruples. 

Tincture of Digitalis, . 1£ drachms. 

Tincture of Squills, . . 3£ drachms. 

Simple Syrup, . . .11 drachms. 

Mix. Give a teaspoonful, in water, three times a day. 
Tonics, such as iron, quiuine, &c, may also"be required. 
When these means fail, tapping the chest, so as to let the 
fluid out, has been resorted to, on many occasions, with suc- 
cess. A good physician should always be consulted in these 



LUNG FEVER. (Pneumonia.) 

Lung fever, or pneumonia, is an acute inflammation of the 
substance of the lungs, and consists of three stages ; viz., 
first, that of congestion, or engorgement ; secondly, that of 
red hepatization ; and, thirdly, that of gray hepatization, or 
purulent infiltration. 

In the first stage, the substance of the lung becomes loaded 
with blood ; and if we listen to the chest, when the lung is 
in this condition, we shall hear a fine, crepitating sound, re- 
sembling that produced by rubbing a lock of one's own hair 
between the finger and thumb, close to the ear. 

If the inflammation proceeds, it passes into the second 
stage, in which the spongy character of the lung is lost, and 
it becomes hard and solid, resembling the cut surface of the 
liver, whence it is said to be hepatized. If we now gently 



LUNG FEVER. 93 

tap the chest with the ends of the fingers, there is dulness 
over the whole of the affected part. And if we listen to the 
chest, no crepitating will be heard. We now come to the 
third stage, which consists of a diffused formation of matter 
in the pulmonary tissue. 

If .the inflammation subsides before the stage of purulent 
infiltration, as it usually does, then the liver-like condition 
of the lung may remain permanent, or may gradually cease. 
In the latter case we shall find the air slowly re-entering the 
lung, as will be indicated by a return of the crepitating 
sound. 

In each stage there is fever, more or less pain in some 
part of the chest, most severe at the commencement ; accel- 
erated and oppressed breathing ; occasionally delirium ; 
cough, and expectoration of a viscid, rust-colored sputa, 
which unite into a mass so tenacious that even inversion of 
the vessel containing them will not detach them. 

Pneumonia may affect one or both lungs ; or, technically 
speaking, may be double or single. 

The right lung suffers twice as often as the left ; about 
once in eight cases both are affected. The lower lobes are 
more obnoxious to inflammation than the upper. The aver- 
age duration of the disease, when uncomplicated, is about 
two weeks ; when complicated, about three. 

More or less bronchitis almost always accompanies pneu- 
monia. It may occur with or without pleurisy. 

Treatment. "When first taken, attention must be paid to 
the bowels,, and a dose of castor oil may be given if neces- 
sary. The patient should go to bed and remain quiet, the 
air of the sick room being kept moist by the evaporation of 
boiling water. The temperature of the room should not be 
allowed to fall below 65° Fahrenheit. From half a tea- 
spoonful to a teaspoonful of R. 21 may be given every two, 
three, or four hours, to promote the action of the skin. It 
should be well diluted with water. Hot fomentations may 
be applied to the affected side of the chest, and when both 



94 MEDICAL AND SURGICAL COMPANION. 

lungs are affected, apply to both sides. The patient's diet 
should be light, as gruel, milk, &c, and he may have for 
drink cold water or lemonade. 

As soon as there are auy indications of greater weakness 
than the patient can support, give freely of strong beef tea, 
or essence of beef, and wine or brandy at regular intervals. 

When the crisis occurs, by sweating or by diarrhoea, care 
must be taken not to check it unnecessarily. During conva- 
lescence, milk, raw eggs, and animal food may be allowed. 

During this disease, whenever there is much restli 
ten to twenty-five drops of laudanum, once or twice a day, 
or oftener, will prove very beneficial. 

"When the patient does not seem to regain his strength 
readily, iron and quinine may be given. 



CONSUMPTION. (Phthisis.) 

Pulmonary consumption, the commonest and most fata 
malady to which the human race is subject, is a constitution- 
al disease, which [days its most conspicuous pari in the lungs. 
A morbid product, called tubercle, or tuberculous matter, is 
found deposited in the areolar tissue, betweeu the air cells, 
iu the air cells themselves, and in the smaller bronchial 
tubes communicating with them. Wherever a particle of 
this matter is deposited from the blood, it continues to in* 
crease by constant addition. In its hard state it is called 
crude tubercle. After a time inflammation arises in the 
pulmonary substance surrounding the deposit, suppuration 
occurs, the tubercular matter softens and breaks down, and 
at length is gradually expelled or raised by coughing, leav- 
ing cavities or ulcers behind, of various sizes. Sometimes 
these cavities close and heal, and the patient recovers ; more 
frequently tubercular matter continues to be deposited on 
their sides, and in other parts of the lungs, until these organs 
become diseased to an extent incompatible with the continu- 
ance of life. 



CONSUMPTION. 95 

Symptoms. The disease usually begins with a short, dry- 
cough, occurring, most frequently, on first rising in the 
morning, and so slight as to become habitual before it excites 
the attention of the patient. It is sometimes accompanied 
by slight difficulty of breathing, increased on exertion, and 
the patient generally loses flesh, is soon fatigued, and easily 
thrown into a perspiration ; or he complains of unusual 
coldness of the body and extremities. Slight dyspeptic 
symptoms, diarrhosa, frontal headache, and a small, fre- 
quent, quick pulse, are also among the early symptoms ; 
and, on inquiry, the patient will often recollect that at some 
previous period he raised a little blood. 

After these symptoms have continued for a variable peri- 
od of several weeks, months, or even years, in consequence 
of a cold, or some trivial exciting cause, the cough becomes 
more constant and troublesome, and is attended by expecto- 
ration, at first of a frothy mucus, afterwards of a more vis- 
cid and opaque substance, ofteu mixed with small, round 
particles of tubercular matter, with pus, or with streaks of 
blood ; or bleeding from the lungs occurs in a more marked 
form, and to a greater extent. 

As the disease advances the cough and difficulty in breath- 
ing become more urgent, the expectoration more abundant, 
the emaciation and weakness greater, the pulse more fre- 
quent ; there are chills at noon or in the afternoon ; the face 
flushes towards evening, the palms of the hands and soles of 
the feet are affected with burning heat ; in a word, hectic 
fever sets in, followed, towards morning, by profuse perspi- 
ration. The patient now rapidly loses flesh ; diarrhoea, 
either due to disordered secretions or to ulcerations of the 
mucous membrane of the intestines, often sets in and ifl- 
- the debility ; the lower extremities frequently be- 
come painful and swollen, and death soon ends the scene, 
— tin: mental faculties remaining clear until the last few 
hours. 

This disease is by some divided into three stages. Dur- 



96 MEDICAL AND SURGICAL COMPANION. 

ing the first, that in which tubercles become developed in the 
lungs, neither the local nor the general symptoms warrant 
us in announcing the presence of any other affection than a 
severe catarrh. In the second stage, the tubercles increase 
both in number and size, so as to compress and obstruct the 
substance of the lung, and occasion difficulty of breathing. 
In the third, or last stage, jhe tubercles become softened ; 
they make an opening for themselves through some of the 
surrounding or involved bronchial tubes, and being thus 
evacuated, they give rise to the formation of cavities. 

By auscultation, or listening to the sounds made by the air 
in passing through the various structures of the lungs in the 
process of breathing, physicians can learn much in regard 
to the condition of those organs. By percussing, or gently 
tapping the chest, they also learn something in regard to any 
internal changes which may have taken place. But auscul- 
tation and percussion can only be practised to advantage 
by physicians whose ears have become accustomed to the 
sounds given forth from the chest, both in health and 
disease, and who have also learned what those sounds indi- 
cate. 

Causes, &c. Consumption may be inherited or it may be 
acquired. It is not contagious. The left lung suffers more 
frequently than the right. The upper and back parts of the 
upper lobes of the lungs are ordinarily the situations in 
which the tubercular deposit first takes place. 

No period of life is exempt from this disease, and it may 
affect the foetus in utero ; but it is most liable to be developed 
between the ages of twenty and thirty. Iu this country, at 
least one death in every eight is caused by consumption. 

'Among the predisposing causes, may be mentioned the 
scrofulous diathesis ; sedentary life ; residence in a low, 
damp, and marshy district ; a close and confined atmosphere ; 
insufficient and unwholesome food ; depressing passions of 
the mind ; dissipation and intemperance ; profuse evacua- 
tions ; immoderate indulgence of the sensual passions ; and 
all causes of debility. 



CONSUMPTION. 97 

As exciting causes, pneumonia (lung fever), catarrh, asth- 
ma, syphilis, small pox, scarlet fever, and measles may be 
mentioned. The dust to which certain artificers are ex- 
posed, — as needle-pointers, stone-cutters, pearl button- 
makers, millers, &c, — often excites disease in the throat, 
bronchial tubes, and lungs. 

Duration. The average is about two years. In acute 
cases fi'om one month to one year. In chronic cases, death 
often takes place after the lapse of years, and after repeated 
attacks. 

Treatment. As this is a constitutional disease, the great 
object of treatment is the removal of this constitutional 
morbid condition. The chief end to be kept in view is the 
prevention of further tubercular deposit ; or, in other words, 
an arrest of the disease. It is extremely desirable for the 
arrest to take place as quickly as possible, in order that the 
amount of deposit may be limited, and the amount of dam- 
age to the lungs proportionably small. And with a view to 
a speedy arrest, the importance of early detecting the dis- 
ease can hardly be overrated. 

This disease is not removable by any known special reme- 
dy or remedies. This, however, is by no means saying that 
there arc not remedies useful in cases of pulmonary con- 
sumption. Important indications are to be fulfilled by 
remedies, but it should be clearly understood that far more 
reliance is to be placed on hygienic, than on medicinal meas- 
ures of treatment. Speaking in general terms, everything is 
to be avoided which tends to impair the appetite, disorder 
digestion, and lower the vital powers. 

The measures indicated arc those which tend to strengthen 
and invigorate. These relate to diet, exercise in the open 
air, clothing, mental encouragement, and change of climate. 

The diet of consumptive patients should be generous as 

Wgards quantity, quality, and variety. The articles should 

be highly nutritious, and adapted to the digestive powers. 

All the varieties of wholesome food which the patient is 

7 



98 MEDICAL AND SURGICAL COMPANION. 

able to take with relish should be allowed, and the appetite 
should be encouraged as much as possible. Meats, milk, 
farinaceous articles, and the different vegetables, are to be 
combined in relative proportions, according to the choice, 
habits, and experience in individual cases. It is desirable 
that cream, butter, and other fatty articles, should enter into 
the diet as largely as possible, without inducing disgust and 
disorder of digestion. The same remark applies to sugar. 

Exercise in the open air, or out-door life, is, of all meas- 
ures, the most important. The physical exercise should be 
accompanied by either mental recreation or occupations 
which iuterest the mind. It should, as far as possible, be 
incidental to pursuits which engage the attention. Adapted 
simply as a hygienic measure, it will rarely be persisted in. 
It is often essential, therefore, for patients to make a radical 
change in business, or, if they are able to devote their time 
to the restoration of health, hunting, fishing, sporting, trav- 
elling, etc., are to be resorted to as a means of securing the 
union of out-door life with an agreeable exercise of the 
mental faculties. The body sbould be protected against 
atmospherical changes by warm clothing ; but a superfluity 
of clothing is to be avoided. The object is to provide ade- 
quate protection, without an undue accumulation of heat and 
perspiration. In a cold or temperate latitude, during the 
winter season, a waistcoat of buckskin or chamois leather, 
worn during the daytime, over a light woollen or silk shirt, 
is to be recommended to patients of either sex, as securing 
the proper protection, without the inconvenience of being 
burdened with an overplus of garments. The feet should be 
well protected against cold and wet. 

Properly clothed, the patient, if he has strength enough 
to go out of doors, should rarely be kept within by the state 
of the weather, but should resolutely keep up habits of out- 
door life, despite the ordinary changes of temperature and 
winds, remaining in the house only on inclement days. 

The cool or cold sponge bath, taken daily, appears to 



CONSUMPTION. 99 

benefit some consumptive patients. It may be safely tried 
and continued, provided it be followed by an agreeable glow. 
The proportion of cases in which an arrest of the disease is 
effected, is sufficient to encourage patients strongly to employ 
the hygienic measures which have been briefly considered. 
The influence of the disease on the mind is to induce 
either an expectation of recovery without effort, or resigna- 
tion to death. It is important for patients to understand that 
very much depends on their own exertions. One of the 
great difficulties in the way of successful management, is a 
passive, patient, tranquil frame of mind, which cannot be 
roused to any vigorous efforts. Persons endowed with reso- 
lution, energy, and perseverance, other things being equal, 
are more likely to struggle successfully with the disease than 
those who are deficient in these mental qualities. 

Change of climate in this disease is frequently beneficial, 
but it may be taken for granted that there is no specific in- 
fluence in any climate. Observation shows that different 
climates are suited to different cases. As a rule, the quali- 
ties which render a climate favorable are uniformity and 
dryness. As regards the latter, the rule is, perhaps, not 
without exceptions : some patients appear to do best in situ- 
ations in which the atmosphere is warm and moist. With 
respect to temperature, a uniform cold climate is best for 
some cases, and a uniform warm climate for other cases. 
It has become quite customaiy of late years to send patients 
to a cold latitude, and in many instances the climate of Min- 
nesota has proved highly serviceable. In other instances a 
change to a warm climate has appeared to accomplish all 
that could be desired. In deciding whether a cold or warm 
climate will be likely to prove most advantageous, the feel- 
ings and choice of the patient are to have considerable 
weight. If, when in health, more vigor and enjoyment are 
habitually experienced in summer than in winter, a warm 
climate will probably be best, and if the reverse be true, a 
cold climate is to be preferred. The condition as regards 



100 MEDICAL AND SURGICAL COMPANION. 

feebleness is an essential point. If the patient be so feeble 
as not to be able to live out of doors in cold weather, or if 
the reaction from the impression of cold be slow and imper- 
fect, a warm climate is more suitable. It is rarely proper 
to send patients to a cold climate, if the disease be consider- 
ably advanced ; and, as a rule, a cold climate is better suited 
to male than female patients. With reference to the partic- 
ular situation to be selected, it should contain resources for 
occupation and mental interest. There must be induce- 
ments for out-door life. It is frequently better to move about 
from one place to another than to remain stationary : as soon 
as a place becomes tiresome*, it is best to leave it. Travelling 
in foreign countries, without any special regard to climate is 
often the best plan, the advantage consisting in the interest 
and inducements to exercise derived from a succession of new 
scenes. A sea voyage is generally useful, and if patients 
are fond of the sea, a long voyage, if practicable, may be 
advisable. Places which are especially the resort of patients, 
are to be avoided. The moral effect of seeing daily exam- 
ples of the different stages of the disease is unfavorable. A 
change is often useful when there is no superiority on the 
score of climate, because it is in this way only, in certain 
cases, that relief from the cares and anxieties of business, 
can be secured. The habits and tastes of the patient are to 
be considered. Persons who are dependent on the associa- 
tions and comforts of home and friends for their happiness, 
will not be likely to be benefited by being sent away, espe- 
cially if alone and among strangers. 

The stage of the disease and the rapidity of its progress 
are points of great importance. It is truly a cruel act to 
send to a distance patients who are in a condition admitting 
of but little prospect of improvement, and who will prob- 
ably not live to return. Although change of climate is often 
an important element in the treatment of this disease, it 
must be borne in mind that this change is to be resorted 
to only in the early stages and in. chronic cases. When sof- 



CONSUMPTION. 101 

tening of the tubercles, or the third stage has begun, it will 
generally be too late to expect much benefit. 

Passing now to consider the remedies which enter into 
the management of this disease, I will speak first of cod- 
liver oil, which may be regarded partly as an article of food, 
and partly as a medicinal agent. To whichever of its con- 
stituents its efficacy may be due, there cannot be a doubt 
that it is, beyond all others, the remedy on which most reli- 
ance can be placed. Of course its virtues are most strik- 
ingly displayed in the earlier stages of the disorder, and in 
cases where there is not a strong inherited predisposition to 
tubercular disease ; but speaking generally, it may be stated 
that the oil proves serviceable at all ages, and in all stages 
of the disorder. The symptoms and physical signs often 
ameliorate under its administration with a rapidity which 
is sometimes quite surprising ; and in favorable cases the 
weight of the body increases, the cough and expectoration 
decrease, the appetite improves, and the night sweats, and 
other unfavorable symptoms, gradually disappear. 

The improvement which results from cod-liver oil is not 
found to follow the administration of neat's-foot and other 
oils, which equally supply an oily matter ; and as in admin- 
istering cod-liver oil we are conveying into the system iodine, 
bromine, phosphorus, and other matters which are known 
to exercise a powerful influence on the animal economy, it 
is probable that the peculiar efficacy of cod-liver oil depends 
partly on the supply of oil which it affords, but partly also 
on its containing elements which are wanting in most cases 
of consumption, and which in such cases it satisfactorily sup- 
plies. But without regard to how or why it proves ben- 
eficial, its extraordinary virtues cannot be doubted, and it 
ought to be administered in all cases of consumption in 
which it does not derange the stomach. Not only does it 
produce increase of weight, but the patients, whilst taking 
it, gain strength and color. 

Sometimes the oil thoroughly disagrees with the stomach, 



102 MEDICAL AND SURGICAL COMPANION. 

giving rise to nausea, acid eructations, and even vomiting, 
together with feverish derangement of the system. In these 
instances it must either be omitted altogether, or adminis- 
tered in small doses, and, at all events, it must be discon- 
tinued until the stomach is brought into better order, and 
has the power to digest and assimilate it. 

But when the oil is tolerated, and under ordinary circum- 
stances, a tablespoonful may be given two, three, or even four 
times a day, and the dose may be cautiously increased to 
three or four tablespooufuls. It should be taken about an 
hour after meals, and may be given floating on a glass of 
wine, whiskey, ale, porter, or milk, whichever proves most 
beneficial and agreeable to the patient. It is nut sufficient 
to persevere in the administration of the oil until some sen- 
sible improvement has taken place ; the very fact of im- 
provement should rather be regarded as a stimulus to further 
perseverance. The deposit of tubercle is so clearly con- 
nected with constitutional derangement, and any material 
alteration in the constitution is notoriously effected so very 
slowly, requiring not weeks or months, but rather years for 
its completion, that if the patient's safety be consulted, we 
must urge him to take the oil for many months after he con- 
siders his health reestablished. If be refuses to do so, the 
probability will be that the improvement will be only tem- 
porary, and, after a short interval of comparative tranquil- 
lity, the system will again get out of order, mischief will 
recommence in an active form, aud our power may not avail 
to arrest it ; whereas if the patient can be persuaded to con- 
tinue taking the oil for a year or two, omitting it only three 
or four times in the twelvemouth, for three weeks or a 
month at a time, while he is enjoying change of air, and is 
otherwise under peculiarly favorable hygienic conditions, it 
is probable that in a considerable proportion of cases the 
tendency to the disease will not only be arrested, but the 
improvement which has occurred will be maintained, even 
after the oil has been discontinued. 



CONSUMPTION. 103 

Alcoholic stimulants seem, in a certain proportion of 
cases, to exert a curative influence, and may be taken in 
connection with the cod-liver oil, or without it, when that 
article cannot be tolerated. Whiskey, wine, brandy, porter, 
or ale, whichever seems to agree best with the patient, may 
be takeu, in proper quantity, three or four times a day. If 
whiskey or brandy is used, the dose may be from two to 
four tablespooufuls ; if wine suits best, from three to six 
tablespoonfuls. When porter or ale agree best, a small 
tumblerful will be a proper dose. 

The fusil oil has been thought by some to affect favorably 
the pulmonary symptoms, but I do not believe it amounts 
to much as a curative agent. When used, three to five 
drops may be taken in a little sweetened water, three times 
a day. 

Touics, as the preparations of iron, Peruvian bark, or 
quinine, often prove serviceable in this disease. Medicines 
to allay superfluous cough — that is, cough not required for 
expectoration — are useful; but expectorant remedies, as a 
rule, are not called for. If they diminish appetite, occasion 
nausea, or disturb digestion, they do more harm than good. 
Soothing inhalations (R. 30, R. 31) are sometimes useful in 
allaying tin: irritation which excites cough. 

The following mixture may often prove serviceable in 
allaying a harsh cough : — 

Take of Sulphate of Morphia, . . .1 grain. 

Syrup of Wild Cherry, . . 1 ounce. 

Syrup of Balsam of Toln, . . J- ounce. 
Mucilage of Gum Arabic, . £ ounce. 

Mix. A teaspoouful may be taken three or four times 
a day. 

When night sweats occur, R. 146 may prove beneficial. 
Gallic acid, in five grain doses, three times a day, often 
pro\ es serviceable. 

For diarrhoea, R. 71, 72, or 74, will prove useful. 



104 MEDICAL AND SURGICAL COMPANION. 

Pain in the chest should be met by counter-irritation, with 
R. 81 or 85. 

Fistula in ano is another symptom, occurring frequently, 
which must not be lightly dealt with. As long as the dis- 
charge is insignificant in amount, and the patient's mind is 
not seriously disturbed by its continuance, so long is it ad- 
visable to confine our efforts to the treatment of the consti- 
tutional malady, and not to disturb the fistula. Any attempt 
at curing it by operation under these circumstances would 
probably be followed by an immediate increase of the cough 
and other pectoral symptoms, and therefore would be high- 
ly injudicious. In some instances the discharge is profuse, 
and constitutes an important source of waste, and the pa- 
tient is so distressed and alarmed at its continuance, that DO 
treatment can be of any avail until his nervous apprehen- 
sions are overcome. He can neither eat nor sleep for think- 
ing of it, and his whole system is depressed in consequence. 

In such cases, the greatest benefit may result from an op- 
eration, combined with the formation of an issue in the arm, 
the use of a proper diet, and the administration of cod-liver 
oil, quinine, iron, and other appropriate remedies. 



SPITTING OF BLOOD. (Haemoptysis.) 

Spitting of blood is one of the most alarming incidents to 
which we are liable. It very often occurs without any 
warning. A slight tickling in the throat, a little cough, 
probably produced by the blood let loose in the air-cells of 
the lungs, and a slightly saltish taste in the mouth, are all 
the inconveniences commonly felt in spitting blood. Some- 
times the blood will be spit up in small quantities, and at 
other times in large mouthfuls. The blood which comes 
from the lungs is always of a light-red color, and comes up 
by coughing. Blood which comes from the stomach is al- 
ways of a dark color, often mixed with particles of food, 



SPITTING OF BLOOD. 105 

and comes up by vomiting. Blood is sometimes discharged 
from the mouth, back part of the nasal passages, and the 
throat, and is liable to be confounded with raising it from 
the lungs. TVhen it comes from the mouth merely, there 
is no coughing or vomiting, and when it comes from the 
upper part of the throat, and the posterior nares, it is 
brought out by mere hawking, and if the throat is examined, 
blood may be seen issuing from the capillary vessels. 

Treatment. The patient should be placed in an easy 
chair, or on a bed, with the head and shoulders raised, as 
the blood cannot so easily issue from the vessels of the 
lungs in that position as when he lies down. He should be 
directed not to talk, or to use exertion of any kind. He 
should be allowed free air, and only a light covering. ' 

A teaspoonful or two of common fine salt, taken into the 
mouth and swallowed, sometimes seems to be efficacious in 
arresting hemorrhage from the lungs, and may be given at 
once. Small pieces of ice held in the mouth may do some 
good. Powders of Gallic acid and opium (R. 72) often 
prove very beneficial. 

The following mixture of turpentine frequently proves 
serviceable : — 

Take of Sulphate of Morphia, . . .1 grain. 

Oil of Turpentine, ... 3 drachms. 

Mucilage of Gum Arabic, . . 1 ounce. 
Syrup of Balsam of Tolu, . 5 drachms. 

Mix. Shake before using, and take a teaspoonful every 
hour or two. The bowels should generally be moved, and 
a Rochelle powder, or dose of Epsom salts, may be given 
for that purpose. 

( Sold water or lemonade may be drank to allay thirst. A 
fight diet should be strictly adhered to until all appearauccs 
of bleeding have ceased. 



106 MEDICAL AND SURGICAL COMPANION. 



CHAPTER VI. 
DISEASES OF THE HEART, &c. 

PALPITATION. 

The term palpitation is given to frequent, strong, and tu- 
multuous movements of the heart, -without appreciable or- 
ganic lesion. 

When existing in an extreme degree, the beats of the heart 
are both heard and felt by the patient, and seen by the by- 
stander. The palpitation is attended by a painful sensation 
of sinking, referred to the region of the heart, or pit of the 
stomach, and spoken of as a "sinking at the heart." In 
some cases there is a tendency to fainting. It generally oc- 
curs in persons of a nervous temperament. 

Causes. The exciting causes are strong mental emotions, 
— joy, grief, auger, sadness, fear, anxiety, violent exercise, 
excessive use of tobacco, tea, or coffee ; debility caused by 
chronic diseases, or occurring during convalescence from 
fevers, or other acute diseases ; excessive loss of blood, 
want of nourishment, intemperance, want of sleep, continued 
anxiety arid distress, dissipation and debauchery ; excessive 
sexual intercourse ; onanism. In females, " change of 
life" 

Treatment. Remove the causes of the trouble, if possi- 
ble, and improve the general health. 

The following mixture will be found useful in controlling 
the action of the heart : — 



ANGINA PECTORIS. 107 

Take of Tincture of Digitalis, . . £ ounce. 

Fluid Extract of Cimicifuga, . £ ounce. 
Compound Tincture of Lavender, i ounce. 
Simple Syrup, . . . . 2£ ounces. 

Mix. A teaspoonful may be taken three times a day for 
a week, when it should be omitted for a time, and resumed 
if necessary. 

ANGINA PECTORIS. 

Angina pectoris is a paroxysmal disease, which has been 
termed a disorder of the breast. 

Symptoms. Those who are afflicted with this disease are 
seized whilst they are walking, and more particularly when 
they walk soon after eating, with a painful and most disa- 
greeable sensation in the breast, which seems as if it would 
take their life away if it were to increase or to continue. 
The moment they stand still, all this uneasiness vanishes. 
In all other respects the patients are, at the beginning of this 
disorder, perfectly well, and in particular have no hurried 
breathing, from which.it is totally different. 

The duration of the seizure rarely exceeds a few minutes, 
though it may last for half an hour, or an hour, or even 
longer. The attacks occur at uncertain intervals of weeks 
or months ; in confirmed cases the periods of recurrence ap- 
proximate more and more with each successive paroxysm. 
The seizure may come on at any time, not only when the 
patient is walking, but even when in bed. The pain is most 
severe, and is attended with a feeling as if life were about to 
cease : in some cases the paroxysm has at once destroyed 
life. 

No favorable prediction can be made in regard to this dis- 
ease ; for if death does not occur in the first or second seiz- 
ure, it generally does so in some subsequent attack. The 
occurs most frequently in advanced life, and is much 



108 MEDICAL AND SURGICAL COMPANION. 

more common in men than in women. In some few in- 
stances it has seemed to have some connection with gout. 

Treatment. During a paroxysm administer stimulants, 
as whiskey, or brandy, and of anti-spasmodics, such as 
ether, opium, &c. 

A belladonna plaster, worn constantly over the region of 
the heart, may do good. 

The return of the seizure is to be guarded against by 
improving the general health, by great attention to diet, and 
by the avoidance of stimulants, excessive exercise, and all 
mental excitement. 

PERICARDITIS. 

Pericarditis, or inflammation of the external covering of 
the heart, is a grave disease. 

Causes. It often arises from acute rheumatism, from the 
contaminated state of the blood produced by disease of the 
kidneys, from damp and cold, and from mechanical injuries, 

Symptoms. High fever ; pain referred to the region of 
the heart, often darting through to the left shoulder blade, 
upwards to the collar bone and shoulder, and down the 
arm : violent palpitation, the motions of the heart being tu- 
multuous, and perceptible at a distance from the patient ; 
irregularity of the pulse, hurried breathing, incapacity of 
lying on the left side, strong pulsation of the arteries of the 
neck, anxiety of the countenance, and frequently noises in 
the ears, giddiness, and bleeding from the nose. 

Treatment. If the disease is not checked quickly, fluid 
becomes effused into the pericardium, or heart-case, and 
when such is the result, a large blister may be placed over 
the part. 

At the commencement of the disease, give a thorough pur- 
gative, as an ounce of Epsom salts, or one composed of five 
grains of calomel and fifteen of jalap. If the inflammation 
be of a rheumatic character, the treatment laid down for 



DISEASES OF THE HEART. 109 

acute rheumatism will be proper. Opium in some form may- 
be given to allay pain. At first the patient's diet should be 
light, consisting of gruel, arrowroot, and mutton broth. As 
soon as the strength begins to fail, however, the diet must 
be more strengthening, and milk, strong beef tea, and wine 
freely allowed. 

ENDOCARDITIS. 

Endocarditis is an inflammation of the membrane which 
lines the interior of the heart and its valves. Severe or- 
ganic disease arises from it. 

Symptoms. A sense of oppression and uneasiness about 
the region of the heart, fever, small, feeble, and intermit- 
tent pulse, great anxiety, cold sweats, oppressive difficulty 
in breathing, fainting, &c. When the inflammation is only 
of limited extent, or when it assumes a chronic form, the 
symptoms are much milder and more obscure. 

Treatment. The same as recommended for pericarditis. 



BLUE DISEASE. {Cyanosis.) 

This disease is characterized by a blue or purplish discol- 
oration of the skin. It generally arises from some mal- 
formation of the heart, permitting direct communication 
between the right and left cavities. 

Treatment. This must be simply palliative, the organic 
cause being irremediable. 



OTHER DISEASES OF THE HEART. 

In addition to the diseases already mentioned, there are 
others of an organic or structural character, as enlargement 
(hypertrophy) and diminution (atrophy) of the heart ; also 



110 MEDICAL AND SURGICAL COMPANION. 

valvular disease, fatty degeneration, dilatation, &c. ; but as 
these diseases can only be detected and properly managed 
by a physician, it will be useless for me to treat of them in 
this work. 

Persons afflicted with organic disease of the heart have 
more or less trouble at all times ; but in cases where the 
disease is purely functional, there will be times when no 
trouble whatever is experienced. 

All who are afflicted with disease of the heart should live 
temperately and regularly, and avoid excitement. 



DISEASES OF THE BLOOD. 
SCURVY. (Scorbutus.) 

This disease consists in a peculiar depraved state of the 
blood, the nature of which is not clearly understood. 

Symptoms. This disease commences with a feeling of 
languor, or general debility, and mental despondency ; a 
sense of fatigue is experienced on the slightest exertion ; the 
face is either pale or sallow, and presents an appearance of 
puffiness; the gums are swollen, soft, and of a purplish 
color, and bleed easily ; the breath becomes offensive, and 
small purple spots appear over the body. These spots, 
which are sometimes very numerous, are generally small 
and circular, resembling flea-bites ; but often, especially when 
the disease is a little advanced, we meet with other spots as 
large as the palm of the hand, sometimes much larger, in 
which the skin is of a variegated violet and green tint, and 
which resemble in every respect the marks produced by a 
severe bruise. 

In advanced stages of the disease, the complexion has a 
more dingy, and somewhat brownish hue ; the gums are 



SCURVY. Ill 

more swelled and more livid, forming in some cases a black, 
spongy mass, which completely covers the teeth ; the teeth 
themselves become loose, and frequently drop out, and the 
debility is such, that the slightest exertion, even the erect 
posture, causes breathlessness and palpitation, and not un- 
frequently an alarming faintness. Bleeding frequently oc- 
curs from mucous surfaces, and the feet become swollen. 
The tongue and appetite often continue unaffected. When 
death takes places, it is produced either by the debility or 
hemorrhage, the intellect remaining sound to the last. 

Causes. The chief cause is the deprivation of proper 
vegetable food. Other causes may contribute, such as long- 
continued exposure, fatigue, the depressing passions, &c. 
The exclusion of fresh vegetable food will not produce it, 
provided fresh animal food can be procured. It occurs most 
frequently on board of ships on long voyages, and occasion- 
ally, also, on land, under similar circumstances. 

Treatment. This is very simple ; all that is requisite 
is to remove the cause by giving plenty of fresh vegetable 
food and acids, especially lemon juice or citric acid. Cab- 
bages and potatoes are also excellent anti-scorbutics ; but 
oranges, lemons, or fruits of that class, if they can be pro- 
cured, should be preferred. The salutary effect of them is 
extraordinary, and such as would scarcely be imagined by 
persons who have not witnessed it. 

If the state of the gums be such as to prevent the patient 
from masticating, he should be kept for a few days on milk 
diet or on soups, in addition to the fruits ; but as soon as 
possible, fresh animal food and vegetables should be given. 
If a patient be very feeble, wine, ale, or porter may be 
taken. 



112 MEDICAL AND SURGICAL COMPANION. 



PURPURA. 

This disease is characterized by the appearance of livid 
or purplish spots, generally commencing on the extremities. 
Two varieties are described — simple purpura, and -purpura 
hemorrhagica, although it is probable they do not essentially 
differ ; in the latter we may have hemorrhage from the bow- 
els, lungs, nose, gums, &c. 

In some cases there are constitutional symptoms, as in 
scurry, especially neuralgic pains in the back. It appears 
often in successive crops, the spots being usually small, but 
at times becoming very large by increase of the effusion. 
Occasionally it is periodical. It is not elevated, nor is it ac- 
companied by any sensatious. It is simply an effusion of 
the coloring matter of the blood. 

Causes. Not well understood. It occurs in depraved 
constitutions, as a general rule, though this is not always 
the case ; it is more common in the young and in the very 
old. It most resembles scurvy in its general character, 
though it differs from it in not being prevented nor cured by 
fresh vegetable food. In purpura, the gums, although pur- 
plish, do not soften, nor swell, nor ulcerate, as in scurvy. 

Treatment. The chief indication is to correct the low 
state of the blood by fresh air, good food, and tonics, as the 
preparations of iron, quinine, &c. 

A milk diet is often very beneficial. 

Astringents and opium are sometimes required to check 
hemorrhage, and in such cases the following powders will 
prove serviceable. 

Take of Gallic Acid, .... 2 drachms. 
Powdered Opium, . . 8 grains. 

Mix, and divide into twelve powders. One may be taken 
in syrup, three or four times a day. Perfect rest is essen- 
tial in severe cases. 



APHTHA, THRUSH, CANKER. 113 



CHAPTER VII. 

DISEASES OF THE ORGANS OF DIGES- 
TION. 

INFLAMMATION OF THE TONGUE. (Glossitis.) 

Symptoms. Pain, heat, and swelling ; the tongue of a 
deeper red color than usual, and occasionally the swelling 
proceeds to such an extent that the cavity of the mouth is 
not large enough to contain the organ, and it projects beyond 
the teeth. This condition, which often occui'S very rapidly, 
sometimes in a few hours, is attended with urgent increased 
frequency of breathing, and requires prompt attention. 

Treatment. Active purgatives should be administered 
by means of injections, and the vapor of hot water may be 
perseveringly inhaled. Six or eight leeches applied around 
the edge of the lower jaw will generally prove very bene- 
ficial. In severe cases, send for a physician without delay. 



APHTHA. THRUSH. CANKER. 

Symptoms. Small, round, white specks, or patches, scat- 
tered over the tongue and lining membrane of the mouth. 
They form a special disease in infancy. In adult age they 
are apt to appear in the course of other diseases. In some 
forms of this disease, microscopical parasitic plants are said 
to be developed in large quantity, and are, in fact, the 
eaUBe of the disease. 
8 



114 MEDICAL AND SURGICAL COMPANION. 

Treatment. The treatment of this disease consists in 
the use of alteratives (R. 67, 68) and tonics (R. 59, 60), 
and the application to the aphthous parts of the following 
preparation : — 

Take of Powdered Borax, . .1 drachm. 

Clarified Honey, . . .1 ounce. 

Mix. Apply to the canker spots, two or three times a 
day, using a camel's-hair brush. 

The following mixture is said to be very efficacious in 
cases attended with the formation of parasitic plants : — 

Take of Sulphite of Soda, ... .1 drachm. 

Rose Water, .... 1 ounce. 

Mix. Apply to the aphthous spots, with a camel's-hair 
brush, two or three times a day. 



MUMPS. (Parotitis.) 

This is a specific contagious inflammatory affection of the 
salivary glands, and of the parotid gland especially. 

Symptoms. Slight fever, with swelling and soreness be- 
neath and in front of one or both ears, the swelling often 
extending along the neck to the chin, and involving the sub- 
maxillary glands. The disease reaches its height in four or 
five days, and then declines. 

Treatment. Give a gentle laxative, as a Rochelle pow- 
der, or small dose of castor oil. If there is much fever, 
R. 21 may be given, and hot fomentations made to the 
swollen parts. 



INFLAMMATORY SORE THROAT. (Tonsillitis.) 

Inflammatory sore throat, sometimes termed quinsy, man- 
ifests itself by smart fever, redness and swelling of the 



DYSPEPSIA. 115 

fauces and tonsils, and difficulty of swallowing, together with, 
in severe cases, pain shooting from the throat to the ear, 
along the course of the Eustachian tube. Under ordinary 
circumstances the inflammation runs a certain course, and 
terminates by resolution in a few days, merely leaving the 
tonsils enlarged ; when violent and prolonged, however, it 
frequently leads to abscess in one or both tonsils. Chills 
often announce the formation of matter, and the pain is very 
severe until the abscess bursts, or is opened artificially. 

Causes. The principal exciting cause of quinsy is cold. 
The liability to it is increased by repetitions of the attacks. 

Treatment. A dose or two of some cooling purgative, 
as Epsom salts, and hot fomentations, or flaxseed meal poul- 
tices to the throat, will prove serviceable. Inhaling the 
steam of hot water often gives great relief. In severe 
cases the outside of the throat may be painted once or twice 
a day, for two or three days, with the tincture of iodine. 



DYSPEPSIA. 

This is one of the most common diseases which physi- 
cians have to treat. Anything which interferes with the 
healthy action of the stomach will give rise to it. 

Symptoms. The symptoms vary, but the most constant 
are loss of appetite, flatulence, heartburn, a sense of fulness 
and oppression after eating, or a feeling of languor and de- 
pression, relieved by taking food. These symptoms, vari- 
ously combined, and generally accompanied by some disor- 
der in the functions of the bowels, in the form of constipa- 
tion, diarrhoea, or the two alternately, and with more or less 
derangement in the functions of the liver, constitute the most 
common form of dyspepsia. In addition to the above, we 
may have cold extremities, headache, dizziness, a foul 
tongue, singing in the ears, pyrosis, &c. 

Causes. Debility, want of exercise, food difficult of 



116 MEDICAL AND SURGICAL COMPANION. 

digestion, overloading the stomach with food, liquids in ex- 
cess, especially hot tea and coffee ; too short or too long 
intervals between meals ; the abuse of spiritous liquors, 
opium, and tobacco ; the frequent use of drastic purgatives ; 
exercise immediately after taking food ; disease of the liver, 
&c. Dyspepsia is a frequent precursor of pulmonary con- 
sumption. 

Treatment. In treating dyspepsia, we must first en- 
deavor to correct any bad habits into which the patient may 
have fallen, and to regulate the diet. Then we must at- 
tempt to restore tone to the stomach, and at the same time 
palliate urgent symptoms as they arise. The most impor- 
tant step to be taken in the cure of dyspepsia is to point out 
to the patient the necessity of changing such habits and 
pursuits as may have tended to give rise to the disease, and 
continue to aggravate it. Unless the causes of the disease! 
are sought out and removed, no permanent benefit need be 
expected from treatment. 

Digestion is always very much improved by those means 
which invigorate the system generally, as by rest and retir- 
ing early, relaxation from severe studies, or from the ha- 
rassing cares and anxieties of business, change of air, sea 
bathing, cold or tepid sponging, horse exercise, the disuse of 
tobacco and of alcoholic stimulants, where these have been 
too freely indulged in, &c. 

The regulation of the diet is of the greatest importance. 
In severe cases, it may be well to give the stomach a com- 
plete rest for a day or two, while we sustain the patient 
by giving an injection of a gill or more of good beef tea 
every third hour. Then, for a time, merely the plainest 
food should be allowed, and only small quantities taken at 
a meal. Milk, to every pint of which may be added a gill 
of lime-water, gruel, soup, and arrowroot, will all be use- 
ful. When these articles can be taken without causing any 
pain or uneasiness, the diet should be increased, and fish, 
poultry, and mutton may be taken. Stale or unfermented 



PAIN IN THE STOMACH. 117 

bread may be eaten ; but vegetables, pastry, cheese, beer, 
and spirits should be forbidden. If any stimulant be need- 
ed, a little sherry wine, or weak brandy and water, will 
prove the least injurious, and in some instances will be even 
beneficial. 

With regard to medicines, several are useful. Pepsin 
(R. 64), the digestive principle of the gastric juice, is very 
valuable when there is an imperfect performance of the 
functions of the stomach, and especially when this is indi- 
cated by disturbance following the use of animal food. The 
tonics (R. 65 and R. 66) often prove serviceable. In some 
instances R. 62 and R. 63 do mnch good. 

If there is great sourness of stomach, alkalies (R. 76, 
R. 77) are indicated. If there is yellowness of the skin, 
or conjunctiva, or the evacuations are clay-colored, or there 
is hemorrhage from the stomach or bowels, the nitro-muri- 
atic acid (R. 148) will generally prove beneficial. In cases 
where a laxative is required, the compound rhubarb pills 
(R. 149) may be used. After the patient's health is re- 
stored, great care must be taken to prevent a relapse of the 
disease. 

PAIN IN THE STOMACH. (Gastralyia.) 

Symptoms. Acute pain in the region of the stomach, 
occurring at a variable interval of from half an hour to 
three hours after a meal, generally relieved by pressure and 
by food. It is associated with other symptoms of dyspep- 
sia, and is often terminated by pyrosis or water-brash. 

Causes. Those of dyspepsia ; strong and sudden mental 
emotions ; the abuse of tea, coffee, and warm liquids. 

Treatment. Remove the causes of the trouble, and give 
one of the following powders, two or three times a day : — 

Take of Sub-nitrate of Bismuth, . . 2 drachms. 

Divide into twelve powders. They may be taken in syrup 
or molasses. 



118 MEDICAL AND SURGICAL COMPANION. 



WATER-BRASH. (Pyrosis.) 

Symptoms. In the morning or forenoon, when the stom- 
ach is empty, or some hours after a meal, and after suffering 
from pain in the stomach, vomiting of a thin, watery fluid, 
in considerable quantity, sometimes of a sour taste, but often 
quite insipid. The free discharge of the fluid generally gives 
relief to the pain, aud puts an end to the attack. 

Causes. The common causes of dyspepsia. 

TREATMENT. That of gastralgia, or pain in the stomach. 
If the liquor vomited be highly acid, R. 76 or R. 77 will 
prove beneficial. 



VOMITING OF BLOOD. (Hasmatemesis.) 

Symptoms. Vomiting of dark-colored grumous blood, in 
greater or less quantity, often mixed with food, and preceded 
by a sense of weight and dull pain in the region of the 
stomach. 

Causes. Predisposing. — The female sex, intemperance, 
peculiarity of constitution. Exciting. — Suppression of ha- 
bitual evacuations, especially of the menstrual discharge 
(vicarious hrematemesis), tumors, compressing the liver or 
spleen, external violence, &c. 

Distinguish this affection from spitting of blood (haemop- 
tysis) from the lungs, by the blood being vomited ; by be- 
ing mixed with food, and not with sputa, and by being of 
a dark color instead of a bright red. 

Vomiting of blood seldom proves fatal, except when oc- 
curring in persons of hemorrhagic diathesis, who are liable 
to bleed profusely, and even unto death, from slight causes, 
as the extraction of a tooth, biting the tongue, &c. 

Treatment. The treatment must consist in abstinence 
from food ; perfect rest, in the horizontal posture ; cold wa- 



INFLAMMATION OF THE STOMACH. 119 

ter and small pieces of ice may be swallowed, and pounded 
ice may be applied to the pit of the stomach in urgent cases. 
The following powders often prove serviceable : — 

Take of Tannic Acid, .... 1 drachm. 
Powdered Opium, . ... 12 grains. 

Mix, and divide into twelve powders. One may be taken 
in a little syrup every third, fourth, fifth, or sixth hour, ac- 
cording to the urgency of the case. 

The oil of turpentine often proves highly beneficial, and 
may be given in the following forni : — 

Take of Oil of Turpentine, . . . £ ounce. 

Mucilage of Gum Arabic, . . 2 ounces. 

Syrup of Balsam of Tolu, . . £ ounce. 

Mix. Give a teaspoonful, in a little cold water, every 
hour or two. When the hemorrhage has ceased, endeavor 
to prevent its recurrence by removing causes, and a strict 
attention to the digestion and general health. In all cases 
of vomiting of blood, a physician should be called as soon 
as possible. 



INFLAMMATION OF THE STOMACH. (Gastritis.) 

Inflammation of the mucous membrane of the stomach 
may be acute or chronic. 

Causes. Very cold water, rapidly swallowed, while the 
body is heated ; irritating and corrosive substances ; fatiguing 
exercise ; over-distention ; improper food ; metastasis of 
gout or rheumatism, &c. 

Symptoms. Vomiting, and a burning, lancinating pain 
in the stomach. There is a desire for cool drinks, and an 
aversion 'to warm, which aggravate the complaint. The 
pulse is small, tense, and quick ; the pain is constant, ex- 
cept for a moment after taking a cold drink ; the pa- 



120 MEDICAL AND SURGICAL COMPANION. 

tient generally lies on his back, and moves as little as 
possible. 

Treatment. The first and most important object in the 
treatment is, to secure for the inflamed organ as much 
rest as possible. With reference to this object, the less of 
anything introduced into the organ the better. To allay in- 
tense thirst, small pieces of ice may be swallowed, or iced 
water, taken often, in very small quantity at a time. It is 
desirable to administer opiates in order to quiet the stomach, 
and render the system more tolerant of the disease. The 
following powders, placed dry upon the tongue, may be 
tried : — 

Take of Sulphate of Morphia, . . .1 grain. 
White Sugar, . . . .12 grains. 

Mix thoroughly, and divide into six powders. One may 
be taken every two, three, or four hours, or as occasion re- 
quires. If vomiting be provoked by this mode of admin- 
istration, half a teaspoonful of laudanum, in a wineglass of 
starch- water, may be injected into the bowels, and repeated 
every three to six hours, if necessary. A mustard poultice, 
followed by hot fomentations, or a blister, four inches square, 
may be placed over the pit of the stomach. If the bowels 
are constipated, relieve them by a soap-suds injection. Ca- 
thartics are not admissible. The importunities of the pa- 
tient for an emetic are to be resisted. It would do harm 
rather than good. Stimulants and solid nourishment will not 
be borne. For a day or two, or until the urgent symptoms 
have subsided, the patient may be sustained by injecting into 
the bowels a gill of strong beef tea, or essence of beef, three 
or four times in the twenty-four hours. If the patient be 
very much prostrated, an ounce or two of wine may be 
added to each injection. 

When the improvement iu the symptoms render it prob- 
able that food will be retained, milk, with the addition of a 
tablespoonful or two of lime-water to every gill, will be 



ULCER OF THE STOMACH. 121 

likely, at first, to be best borne. It should be given in small 
quantities at short intervals. Other forms of food may be 
gradually added. 

Chronic Inflammation of the Stomach is much 
more common than the preceding, and fortunately much 
milder. 

Causes. Excess in eating and drinking ; unwholesome 
food ; an occasional increase of dyspepsia, &c. 

Symptoms. Pain in the region of the stomach, increased 
by pressure ; and immediately on taking food, with constant 
nausea or sickness, the stomach rejecting food as soon as it 
is swallowed, or after a short interval. The tongue is some- 
times red at the tip and edges, and furred in the centre ; at 
others morbidly red over the entire surface, but in many 
cases perfectly clean. The bowels are generally costive. 

Treatment. In the more severe cases, half a dozen or 
more leeches may be applied over the region of the stom- 
ach, and followed by a blister, mustard poultice, or fomen- 
tations. In less severe cases, the leeches will not be re- 
quired. The diet should consist of gruel, arrowroot, or 
sago, made with water or milk, to the entire exclusion of 
solid food, till the sickness and tenderness on pressure dis- 
appear, when the patient may be allowed gradually to re- 
sume his usual diet. 

The bowels may be kept open by Rochelle powders or 
castor oil. 

ULCER OF THE STOMACH. 

This is an interesting disease, variously spoken of by 
authors as the simple, chronic, or perforating ulcer of the 
stomach. 

The ulcer is more frequent in the female than the male, 
in the proportion of nearly two to one. It is specially a 
disease of middle and advancing life, and is more frequent 
in the poor than in the rich. The ulcer varies in. size in 



122 MEDICAL AND SURGICAL COMPANION. 

different cases, being sometimes so small as to be discerned 
with difficulty, and sometimes of the size of a half dollar, 
or dollar, or even considerably larger. If small in size, it 
has generally a round or oval form, and presents an appear- 
ance, in some cases, as if a portion of the tissues had been 
punched out. About half the instances of this disease un- 
dergo what is probably a spontaneous cure ; in exceptional 
cases, the ulcer has been fatal in ten days, generally by 
perforation, sometimes by exhaustion, caused or hastened 
by vomiting, and very rarely by hemorrhage. 

When perforation of the stomach takes place, its contents 
are generally poured into the abdomiuial cavity, and give 
rise to fatal inflammation. 

Symptoms. The most constant symptom is pain in the 
back and pit of the stomach, and when in the latter region, 
it is frequently described as dull and sickening, and it is 
increased by food. There is occasionally eructation of a 
sour fluid, and at times nausea and vomiting. The patient 
generally loses flesh, but otherwise the constitutional symp- 
toms are usually slight. After the disease has continued 
a longer or shorter time, perforation may occur ; or, failing 
this, there may be a severe attack of hemorrhage, indicated 
by vomiting of blood. But iu favorable cases, the ulcer 
gradually heals, the pains diminish, and the patient com- 
pletely recovers. 

Treatment. In the treatment of this disease, we must 
endeavor to support the system, and facilitate the healing 
of the ulcer. "When the pain is very severe, a mustard 
poultice may be applied over the stomach, and followed by 
hot fomentations. In obstinate vomiting, or in hemorrhage, 
the application of ice is more advisable. Small pieces of 
the same may be occasionally swallowed. Laudanum or 
morphine may often be administered with very great ad- 
vantage. 

The patient's diet in this disease should consist of those 
nutritious articles of food which will be best retained by the 



CANCER OF THE STOMACH. 123 

stomach, and give rise to the least inconvenience. Milk and 
fai-inaceous substances will be best borne. Condiments, al- 
coholic stimulants, solid and indigestible food of any de- 
scription, should enter as little as possible, or not at all, into 
the diet. The quantity of food taken at a time must be 
small, and the intervals regulated according to circum- 
stances. Milk and other liquids should be taken cold. . 
Lime-water added to milk renders it less likely to occasion 
disturbance. Quietude of the body is to be enjoined, more 
especially during the process of digestion. Cathartics are 
injurious in this disease, and constipation, if it exist, is to 
be relieved by injections. 

When an improvement in the symptoms renders it prob- 
able that the ulcer is healing, great care in diet is im- 
portant to prevent a relapse. 



CANCER OF THE STOMACH. 

Symptoms. In the early stage of the disease the symp- 
toms are very obscure. They are either those of dyspepsia 
or chronic gastritis. But after a longer or shorter interval, 
during which the patient loses flesh, and obtains little or no 
relief from his dyspeptic symptoms, a circumscribed tumor 
may be discovered in the region of the stomach. At this 
stage of the disease the symptoms are generally of a more 
marked character. The pain is described as burning, 
gnawing, or cutting ; and there are acid or bitter eructa- 
tions, with nausea and frequent vomiting of food, of mucus, 
of blood, or of a dark grumous matter ; constipation ; great 
emaciation, and a sallow countenance. 

Causes. Predisposing. — The cancerous diathesis. JEx- 
viting. — Long-continued dyspepsia. All causes of inflam- 
mation or congestion of the stomach. Depressing passions. 

Treatment. This can only be palliative ; for the dis- 
ease mukes continual progress, exhausts the powers of 



124 MEDICAL AND SURGICAL COMPANION. 

life, and, in the majority of cases, causes death within one 
year. 

Laudanum or morphine, administered either by the mouth 
or bowels, will be necessary ; it should be given in free and 
repeated doses to subdue the pain. "When the vomiting is 
very severe, nourishment, in the form of beef tea, must be 
given by means of injections ; where it can be borne, how- 
ever, a milk diet will be beneficial. 



INFLAMMATION OF THE INTESTINES. 

{Enteritis.) 

Inflammation of the intestines, or bowels, varies much in 
severity, being sometimes so slight as hardly to attract at- 
tention, but often so severe as to threaten, or even rapidly 
destroy life. 

Symptoms. Chills, hot skin, thirst, hard and rapid pulse. 
There is acute pain in the abdomen, increased by pressure 
over the inflamed part, and gradually, in severe cases, ex- 
tending to the whole abdomen, accompanied by swelling and 
tension. The patient lies on his back, with the knees drawn 
up, and can scarcely suffer the pressure of the bed-clothes. 
In colic, it must be remembered, pressure upon the abdo- 
men gives relief instead of pain. There is obstinate cos- 
tiveness ; also nausea and frequent vomiting, the matters 
thrown off being generally bilious, aud in some instances 
highly offensive. The urine is high-colored, and there is 
great prostration of strength. In fatal cases, the swelling 
and pain increase ; the extremities grow cold ; the skin 
is bedewed with a soft sweat ; and death takes place from 
exhaustion, preceded by a cessation of pain. This disease 
sometimes occurs in young children from six to eight 
months old. The child is hot and restless in the early 
stages, and suffers from thirst ; the tongue is dry, or covered 
with a brownish crust ; there is frequent screaming ; dis- 



INFLAMMATION OF THE INTESTINES. 125 

turbed sleep ; vomiting ; pain in the bowels, increased on 
pressure, and in some cases diarrhoea, the feces being often 
discharged with considerable force. Thus far the disease 
does not diiFer much from a sharp attack of diarrhoea. Se- 
vere constitutional symptoms, however, soon set in, such as 
high fever, thirst, vomiting, dryness of the tongue, &c, fol- 
lowed by a rapid and unexpected exhaustion, or sometimes 
by a morbid disposition to sleep, with a peculiar pale, waxen 
appearance of the body. These symptoms may come on 
before the disease has lasted any considerable time, and 
whilst it can scarcely be distinguished from the ordinary 
bowel complaints of children. It should be remarked that 
an erythematous redness is generally observed around the 
anus. 

Treatment. Twenty-five or thirty drops of laudanum, or a 
morphine pill (E. 45), may be given to an adult once in two, 
three, or four hours, according to the urgency of the symp- 
toms. Hot fomentations perseveringly applied to the abdo- 
men will give great relief. All purgatives are to be rigidly 
avoided, but the bowels may be relieved by injections of 
warm water thrown up in large quantity, gradually and 
slowly. The diet should be very simple, and ought to con- 
sist chiefly of gruel, milk, or beef tea. Cold water may be 
freely allowed. When there is a disposition to prostration, 
stimulants, as wine, brandy, or whiskey, may be resorted 
to. After the inflammation has ceased, mild laxatives, as 
castor oil. or Rochelle powders, may be required. In chil- 
dren, the same kind of treatment must be pursued, though the 
preparations of opium, — laudanum, morphine, &c, — must 
be given to them with caution. The warm bath, and hot 
fomentations, or linseed-meal poultices to the abdomen, will 
give great relief. If the child is at the breast, no other food 
should be allowed ; otherwise, the diet must be very mild, 
consisting chiefly of milk with a little broth. 



126 MEDICAL AND SURGICAL COMPANION. 

COLIC. 

Symptoms. Pain in the bowels, especially about the 
umbilicus, occurring in paroxysms, and relieved by pressure. 
It is accompanied by constipation, and often by vomiting. 
There is no fever, no quickness of pulse, and no depressing 
anxiety, as in inflammation of the intestines. 

Causes. Acrid or indigestible food ; redundance of acrid 
bile ; collections of hardened feces ; wind ; certain metallic 
poisons, as lead ; worms, &c. 

Treatment. We must first endeavor to relieve the pain, 
and get the bowels to act. If the trouble is caused by wiud, 
give twenty-five drops of laudanum, aud a teaspoonful of es- 
sence of peppermint, in a little warm water, at once. After 
the patieut becomes easy, give an ounce or two of castor-oil, 
or a good dose of Epsom salts, to clear the bowels. In cases 
arising from indigestible food, or a redundance of acrid bile, 
— which will be indicated by the patient's vomiting a yel- 
lowish, bitter fluid, — first give half a teaspoonful of bicar- 
bonate of soda in a gill of cool water, and immediately 
afterwards a purgative, consisting of three compound cathar- 
tic pills, or five grains of calomel aud fifteen of jalap. If 
the pain is very severe, or the inclination to vomit such that 
nothing can be retained on the stomach, one or two opium 
(R. 44) or morphine (R. 45) pills may be given to produce 
relief, before giving the cathartic. The application of a 
mustard poultice and hot fomentations to the bowels must 
not be neglected. The cathartic may be aided by a liberal 
warm water or soap-suds injection. This is often termed 
Bilious Colic. 

In Lead Colic, or Colica Pictoxum, so called from its 
former frequency among the Pictones, or inhabitants of 
Pictou, there are superadded to the former symptoms a 
twisting pain around the uavel, with retraction of the abdom- 
inal integuments towards the spine, and pain in the back. 
In nearly all cases of lead colic a blue line may be observed 
around the edges of the jrums. 



colic. 127 

Cause. This disease is caused by the introduction of 
lead into the system in sufficient quantity to give rise to its 
morbid effects. It may be introduced through the lungs, 
stomach, the mucous membrane in other parts, and the skin. 
Certain occupations involve the inhalation of lead. Persons 
employed in the manufacture of lead paints are most ex- 
posed, and of those who suffer from lead poisoning, the 
largest proportion are of this occupation. Next to this 
class, painters are most exposed. More or less exposure, by 
inhalation, belongs to a great number of occupations, such 
as paper-staining, grinding of colors, glazing cards, man- 
ufacturing earthen pottery, plumbing, shot-making, &c. 
Lead poisoning has repeatedly occurred from sleeping in 
newly-painted rooms. Lead may be introduced through 
the stomach in various articles of food and drink. Spurious 
wine and cider are sometimes adulterated with lead to give 
them sweetness. 

Iu the treatment of severe cases of lead colic, laudanum 
or morphine must be given to relieve pain, and active 
cathartics to open the bowels. A mustard poultice, followed 
by hot fomentations to the abdomen, should not be neglected. 
As a cathartic, five grains of calomel and fifteen of jalap 
may be given ; or, if preferred, an ounce of Epsom salts 
dissolved in half a pint of water. An hour or two after 
the cathartic lias been administered, an injection of warm 
water or soap-suds may be given. The bowels must be 
thoroughly acted upon or purged. After the urgent symp- 
toms have subsided, the following medicine may be taken 
for a considerable time to remove the lead from the sys- 
tem : — 

Take of Iodide of Potassium, . . 8 scruples. 
Water, . . • . .3 ounces. 

Syrup of Orange Peel, . . 1 ounce. 

Mix. One teaspoonful maybe taken iu a wineglass of 
water after each regular meal. 



128 MEDICAL AND SURGICAL COMPANION. 



DIARRHCEA. 

Symptoms. In addition to the looseness of the bowels, or 
purging, there is generally some degree of nausea, a furred 
tongue, foulness of breath, flatulence, griping pains, acrid 
eructations, constant desire to evacuate the howels ; more- 
over, the stools are unhealthy. 

Causes. The use of improper food or decaying fruit, 
great mental emotion, exposure to cold or too great heat. 
From the latter cause, relaxation of the bowels is common 
during the summer months. 

Treatment. This will, of course, depend upon the cause. 
When the purging arises from the presence of some offend- 
ing matter in the intestinal canal, the expulsion of such 
matter must be aided by giving a dose of tincture of rhu- 
barb, castor-oil, or Epsom salts, combining ten to twenty- 
five drops of laudauum with the dose, if there be much paiu. 
If no such cause exist, give a powder composed of three 
grains of calomel and one of opium, and three hours after- 
wards a dose of castor-oil. The patient should keep quiet, 
and lay down when convenient. Gum arahic water, cool 
water, and liquid nourishment only should be allowed dur- 
ing, and for a few days after the attack. If the diarrhoea 
does not cease soon after the operation of the cathartic, 
opium and astringents (R. 71 or 74) may be given. 



DYSENTERY. 

This disease consists chiefly in inflammation and ulcera- 
tion of the large intestine, or colon and rectum. 

Symptoms. At the commencement there is uneasiness, 
and pain in the abdomen, of a griping character, with a fre- 
quent inclination to go to stool, which is followed by relief. 
As the disease becomes developed, the desire to go to stool 



DYSENTERY. 129 

is more frequent, and the ease which succeeds more tran- 
sient; the evacuations are thin, mucous, and bloody, and 
frequently mixed with small, hard, separate lumps of feces. 
The scanty evacuations soon produce distress rather than 
relief; the patient is constantly tormented with a desire to 
go to stool, and griping ; the stools become fetid, dark-col- 
ored, and mixed with shreds of lymph, and the bladder 
sympathizes with the bowels, causing frequent desire to uri- 
nate. In all cases there is more or less fever and constitu- 
tional disturbance ; the tongue is furred ; pulse quick and 
small; skin harsh, hot, and dry; thirst urgent; no appe- 
tite ; hurried breathing, and great prostration. This is a 
serious and often fatal disease. 

Causes. Cold and wet, contagion, malaria, polluted wa- 
ter, bad food, drastic purgatives, &c. 

Treatment. In commencing the treatment of this dis- 
ease, it is proper to well clear out the bowels, and for this 
purpose a large dose of castor-oil may be given, and with 
it twenty-five or thirty drops of laudanum, to relieve pain. 
Instead of the oil, I sometimes give the following mix- 
ture : — 



Take of Epsom Salts, 
Laudanum, 
Peppermint Water, 
Pure Water, 



1 ounce. 
£ drachm. 
3 ounces. 
3 ounces. 



Mix. A tablespoonful may be given to an adult, in a 
little water, every half hour, until free watery discharges 
from the bowels take place. This seems in most cases to 
give the patient great relief. After the bowels have been 
well cleared out, half a teaspoonful of laudanum, mixed 
with two or three tablespoonfuls of thin warm starch-water, 
may be injected into the bowels, and this injection may be 
repeated <5nce in three to six hours, or often enough to pre- 
vent the patient suffering from pain. Warm fomentations 
and hot poultices to the abdomen always give relief. If 



130 MEDICAL AND SURGICAL COMPANION. 

a syringe is not at hand with which to administer the lau- 
danum and starch injection, an opium (R. 44) or morphine 
(R. 45) pill, or twenty-five drops of laudanum, may be 
taken every three to six hours as a substitute. 

After two or three days, if the disease continue, the purga- 
tive may be repeated, if not contra-indicated by the feebleness 
of the patient ; and afterwards the use of opium resumed. 
Attention must invariably be paid to the diet ; emollient 
drink, — gum-water or barley-water, — milk, arrowroot, and 
essence of beef only being allowed during, as well as for a 
few days after the attack. 

In severe cases the patient should be confined to the bed, 
not even being allowed to rise to use the vessel, as the more 
quiet the bowels are kept the better. When there is con- 
siderable hemorrhage from the bowels, astringents (R. 71 
or 74) may be used. When there is much prostration, 
a little brandy and water may be given every two or three 
hours. Dysentery being a grave disease, requiring careful 
management, a physician, when obtainable, should always 
be> called to take chanre of the case. 



CHOLERA MORBUS 

By cholera morbus, is meant that peculiar affection of the 
alimentary canal, characterized by vomiting and purging, 
and attended frequently with more or less cramps or spasms 
of the abdominal muscles, and also of the extremities, and, 
in severe cases, with considerable prostration. 

Symptoms. The disease commences with a feeling of op- 
pression in the stomach and bowels, with perhaps chilliness, 
and a feeling of great distention, with violent pain in the 
abdomen. Soon there is nausea and griping pains, with 
obstinate vomiting, and copious liquid discharges from the 
bowels. The pulse becomes weak and frequent, the skin 
cool and moist, the strength is prostrated, and, along with 



MALIGNANT OB ASIATIC CHOLERA. 131 

more or less severe cramps in the bowels and extremities, 
there is sometimes wandering of the mind, or slight de- 
lirium. 

If the discharges and cramps continue, they may lead on 
to a fatal termination. 

Causes. Excessive heat, or sudden transitions from heat 
to cold ; food of difficult digestion ; unripe or decaying 
fruit, or an excessive quantity of ripe fruit ; putrid meat ; 
decayed vegetables, &c. This disease occurs during the 
summer months. 

Treatment. The patient should be confined to bed, in a 
cool, airy room. A teaspoonful of bicarbonate of soda or 
saleratus may be added to a tumblerful of cool water, which 
may be drank at once. Then give an opium (R. 44) or 
morphine (R. 45) pill, or thirty drops of laudanum, and 
repeat it in half or three fourths of an hour, unless the pain, 
vomiting, and purging cease. If the opiate first given is 
vomited immediately, or within fifteen minutes, give the 
second dose at once. Our aim should be to give sufficient 
to relieve the urgent symptoms within an hour or two ; 
alter which the dose may be repeated every two, three, or 
four hours, or as occasion requrres, lengthening the intervals 
between the doses as the patient improves. Mustard poul- 
tices to the abdomen and extremities prove serviceable. 

"When the cramps in the extremities are severe, rubbing 
the limhs briskly will ease the patient. When there is great 
prostration, brandy and water may be taken, as occasion 
requires. The diet should at first be light, as gruel and 
milk ; and when the disease has subsided, the usual diet 
must be gradually resumed. 



MALIGNANT OR ASIATIC CHOLERA. 

This is probably the most fatal disease known in the an- 
nals of medicine. We are wholly ignorant of its origin. 



132 MEDICAL AND SURGICAL COMPANION. 

All that our experience has taught us is this : that the dis- 
ease attacks the poor in a much larger proportion than the 
rich ; and that as we remove destitution, filth, foul air, and 
the causes of disease generally, so we destroy the agencies 
through which this formidable malady operates. 

Symptoms. The disease does not always begin in the 
same way. In a few cases it makes its attack suddenly ; 
the patient vomits once or twice, or passes one or two loose 
motions; complains of giddiness, blindness, or deafness; 
falls down, and expires in a few minutes. Such cases are 
rarely seen out of India. In the majority of cases, the fol- 
lowing is the order of the symptoms : After a preliminary 
attack of diarrhoea, of greater or less severity, and contin- 
uing for some hours or days, the patient is seized Avith 
symptoms of collapse or prostration, accompanied, in most 
cases, by vomiting. The acts of vomiting and purging 
are generally unattended by pain or tenderness in the abdo- 
men ; and the matters rejected from the stomach and bowels 
are free from bile, have a faint fishy odor, or are altogether 
inodorous, and resemble yeast ; or they consist of a thin, 
colorless serum, or they bear a close resemblance to rice- 
water, and are familiarly known as " rice-water discharges." 
Sometimes they have a pink color, or the deeper hue of port 
Aviuc. Severe and painful cramps commence in the fingers 
and toes, and rapidly extend to the calves of the legs, to 
the thighs, and muscles of the abdomen; the eyes are 
sunken, and surrounded by a dark circle ; the features con- 
tracted and sharpened ; the expression of countenance indif- 
ferent and apathetic ; the face, extremities, and sometimes 
the whole surface of the body assumes a leaden, bluish, or 
purple hue ; the limbs are shrunken and contracted ; the nails 
blue ; the hands clammy and sodden ; the surface covered 
with a profuse cold sweat ; the pulse thready or impercepti- 
ble at the wrist, arm, axilla, temple, or neck ; and if a vein 
or artery is opened, the blood trickles away, thick and dark. 
In spite of the extreme coldness of the surface, the patient 






MALIGNANT OR ASIATIC CHOLERA. lS3 

complains of heat, throws off the bedclothes, and suffers from 
great restlessness and incessant jactitation ; complains of a 
burning heat in the region of the stomach, and is tormented 
with thirst ; the respirations are below the number in health, 
the inspiration difficult, and the expiration short and con- 
vulsive ; the voice is plaintive, the patient speaking in a 
hoarse, sepulchral whisper ; the breath feels cold as it issues 
from the mouth ; the tongue is white, or of a leaden color, 
cold and flabby. The secretion of urine is entirely sup- 
pressed, or a small quantity of limpid urine is passed, and 
there is an earthy or cadaverous odor exhaled from the 
body. In this state of collapse the disease often proves 
fatal, the patient dying without a struggle, and retaining his 
faculties to the last. In other cases the patient gradually 
rallies, the pulse rises, the blueness of the surface disap- 
pears, the body resumes its warmth, the cramps and vomit- 
ing cease, and a rapid and complete recovery takes place. 

Duration. In fatal cases, from a few minutes to twenty- 
four hours, or more. More than half the fatal cases die 
within the first twenty-four hours. The average duration is 
about two days. 

Causes. Predisjjosing. — Debility ; impaired health ; in- 
temperance ; impure air ; impure water ; low and damp 
situations ; the summer and autumn seasons. Exciting. — 
A peculiar poison diffused through the atmosphere. There 
is also reason to believe that the disease spreads by conta- 
gion, though the contagion is not so intense as to cause 
anxiety among the attendants on the sick ; and by means 
of water polluted by cholera evacuations. 

Treatment. The preliminary diarrhoea requires the 
treatment of common diarrhoea. In the ordinary run of 
cases, R. 71 or R. 74 will prove serviceable, the diet being 
restricted to gruel or arrowroot, made with milk. In more 
severe cases, an opium (R. 44) or morphine (R. 45) pill 
may Ijc taken every one, two, or three hours, according to 
the severity of the case, until five or six have been taken, 



134 MEDICAL AND SURGICAL COMPANION. 

unless relief be sooner obtained. In epidemics of Asiatic 
cholera, patients suffering from diarrhoea should be prompt- 
ly treated and carefully watched. Perfect quietude is im- 
portant, and the patient should not be permitted to get up to 
go to stool, but should be provided with a bed-pan, and he 
should be urged to resist, as much as possible, the desire 
to evacuate the bowels. He should be restricted to a small 
quantity of water, or brandy and water, given at short in- 
tervals, or to small pieces of ice. 

When the disease is arrested by these means before pro- 
ceeding to the stage of collapse, the recovery is usually 
speedy. Regulated diet, rest, with perhaps a tonic (R. 
146), suffice for the cure. The bowels should be allowed to 
remain constipated for several days, and then, if move- 
ments do not spontaneously occur, simple warm water in- 
jections will probably be sufficient ; if not, a little rhubarb 
or castor -oil may be given. 

In some cases, owing to persistent vomiting and frequent 
purging, remedies are not retained sufficiently long to exert 
their effects, and then this course of treatment may fail ; 
and it is not available when, from any cause, the stage of 
collapse or prostration occurs so quickly that there is not 
time enough to obtain remedial effects. These difficulties 
are equally in the way of success from any remedies. 

In a large proportion of cases, after collapse has taken 
place, little can be done with much hope of success. Even 
if the vomiting and purging cease, recovery may not follow. 
The blood may have been damaged irremediably. Recov- 
ery, however, takes place in a certain proportion of cases, 
and under a great variety of treatment. It may take place 
when no treatment is pursued. The object of treatment iu 
this stage, aside from the arrest of vomiting and purging, 
is to excite and aid the efforts of nature in restoring the 
circulation, together with the functions dependent thereon. 
The measures to be employed for this object are external 
heat r stimulating applications to the surface, brandy or 



OBSTRUCTION OF THE BOWELS. 135 

whiskey, and nourishment. The application of heat may be 
made by means of warm blankets, or bottles of hot water 
placed about the body. A large mustard poultice may be 
applied over the abdomen, and smaller ones to the extremi- 
ties. Brandy or whiskey and water should be given as 
freely as the stomach will bear, always recollecting the risk 
and the evils of inducing vomiting. It will be most apt to 
be retained if given in small quantities at a time, and often 
repeated. If vomiting be provoked by either drinks, rem- 
edies, or food, more or less injury is done. Stimulants, 
such as capsicum, ginger, &c, are appropriate, if they are 
grateful to the stomach, and retained. Concentrated nour- 
ishment — essence of beef, chicken broth, and milk — may 
be given in small quantities at a time, if retained by the 
stomach. It is doubtless desirable to introduce liquid into 
the system as far as possible. The only objection to the 
free drinking of water is the risk of provoking vomiting. 
Small lumps of ice should be freely allowed. If the patient 
emerge from the collapsed state, support the system by the 
moderate use of brandy or whiskey, and by nourishment. 
The patient will require close attention for some days, and 
any unfavorable symptoms which may arise must receive 
prompt attention. 



OBSTRUCTION OF THE BOWELS. 

This much to be dreaded disorder may arise from several 
conditions, the most common of which is, perhaps, strangu- 
lated hernia. It may also be caused by the reception of a 
portion of intestine into another portion (intussusception) ; 
by the twisting of a portion of intestine around another 
portion of intestine, &c. 

Symptoms. The chief symptoms are constant vomiting, 
which is at first simple, consisting of the contents of the 
stomach and mucus, but which in a few hours or days 



136 MEDICAL AND SURGICAL COMPANION. 

becomes fecal ; pain varying in degree, often very severe ; 
great mental depression, and constipation. In almost all 
instances the prostration sets in early. The lower the ob- 
struction is situated the less urgent will be the vomiting. 

Treatment. In the management of obstinate constipa- 
tion, we at first resort to the use of purgatives and injections. 
An ounce or two of castor-oil, into which should be put 
thirty to forty drops of laudauum, may be taken at once ; 
and soon after a quart or two of warm soap-suds may be 
injected into the bowels. If we are convinced, however, 
that there is some mechanical obstruction, another plan 
must be pursued ; for under such circumstances, purgatives 
will generally do harm rather than good. Laudanum may 
be given in doses of thirty to forty drops, and the dose re- 
peated in an hour or two, if necessary to relieve pain or 
arrest vomiting. Hot fomentations may be applied to the 
abdomen. At the same time large quantities of soap-suds 
— one or two quarts — may be thrown into the bowels with 
a proper syringe. The patient must be advised to abstain 
as much as possible from food and liquids, being assured 
that the more he takes the more his sufferings will be in- 
creased. If the first injection does not give relief, another 
may be given in an hour or two. Physicians sometimes in- 
ject air into the intestines in these cases with good effect. 
When these means fail, the obstruction may sometimes be 
overcome by a surgical operation. 



WORMS. 

Several kinds of worms are found inhabiting the intes- 
tinal canal — the long thread- worm, large round-worm, small 
thread-worm, tape-worm, &c. 

The large round-worm is found in the small intestines, 
especially of ill-fed children. It somewhat resembles in 
size the common earth-worm, varies in length from six to 



WORMS. 137 

nine inches, and is of a light yellow or cream color. Al- 
though the habitat of this worm is the small intestines, yet 
it may pass into the stomach, or downwards into the large 
intestine, and consequently be vomited in the one case, or 
passed with the stools in the other. Sometimes these worms 
are very numerous. An instance is recorded in which a 
girl voided upwards of two hundred in one week. The 
symptoms which this worm gives rise to are thirst, disturbed 
sleep, with grinding of the teeth, pallid countenance, fetid 
breath, swelled abdomen, emaciated extremities, depraved 
appetite, slimy stools, itching of the nose and anus, and 
frequent desire to go to stool. 

The small thread-worm, or " pin-worm," is found in the 
rectum or lower bowel, and is the smallest of the intestinal 
worms, averaging only about a quarter of an inch in length. 
It gives rise to intolerable itching and irritation about the 
anus, desire to go to stool, depraved appetite, picking of the 
nose, fetid breath, and disturbed sleep. 

The common tape-worm exists in the small intestines, 
and varies in length from five to ten or more feet, and in 
breadth from one line, at its narrowest part, to four or five 
at its central or broadest part. The head of this parasite 
is small aud flattened, having in its centre a projecting 
papilla, armed with a double circle of hooks, around which 
are four suckers or mouths, by which nourishment is im- 
bibed. The symptoms of its presence are not very striking, 
its existence being generally unsuspected until single joints 
arc passed in the stools ; in many cases, however, there is a 
continual craving for food, debility, pain in the stomach, 
emaciation, and itching about the nose and anus. The most 
conclusive sign of intestinal worms, of whatever kind, is 
the passage of some of them, or joints of them, in the feces ; 
aud iudeed without this the other symptoms are of but little 
value. 

Treatment. For the common round-worm, give R. 34 or 
11. .'I"). For tape-worm, R. 36. For the small thread-worm 



138 MEDICAL AND SURGICAL COMPANION. 

or " pin- worm," iojections of salt-water (R. 37), or a solu- 
tion of aloes (R. 38), generally prove effectual. 

After worms have been removed, some tonic (R. 63 or 
R. 146) may prove beneficial in preventing their re-appear- 
ance. Patients should also be directed to take plenty of 
salt with their food, and to have the latter well cooked. 



INFLAMMATION OF THE LIVER. 139 



CHAPTER VIII. 
DISEASES OF THE UVER AND SPLEEN. 

INFLAMMATION OF THE LIVER. 

Inflammation of the liver may be acute or chronic ; 
both forms are rare in this climate, but common in tropical 
countries. 

Causes. All the common causes of inflammation ; bil- 
iary concretions ; the violent operation of emetics ; external 
injury; intense heat ; hot climates ; intemperance, &c. 

Symptoms. The symptoms of acute inflammation of the 
liver are, high fever, hot skin, thirst, and scanty urine, the 
fever sometimes assuming a typhoid character ; pain, more 
or less severe, in the region of the liver, increased on pres- 
sure, deep inspiration, or cough ; inability to lie on the 
Jeft side ; a yellow tinge of the eye, and often complete 
jaundice ; hurried breathing ; sympathetic cough, and vom- 
iting, and hiccup. In affections of the liver, the right col- 
lar-bone and shoulder become the seats of gnawing and 
aching sympathetic pains. 

Terminations. The most favorable termination of acute 
inflammation of the liver is resolution. When this happens, 
the paiu and fever gradually abate, and the patient is soon 
well. The inflammation may, however, go on to diffused 
Suppuration, or to the formation of circumscribed abscesses, 
or even to gangrene. 

Abscesses of the liver sometimes attain a great size, 
and in extreme cases may contain several pints of pus or 



140 MEDICAL AND SURGICAL COMPANION. 

matter. They may burst internally, and give rise to fatal 
inflammation. Most frequently, however, when the matter 
gets near the surface of the gland, adhesive inflammation 
is set up in the structures immediately above it, and lymph 
is poured out, which glues the organ to adjacent parts — 
to the abdominal parietes, the diaphragm, stomach, or 
some part of the intestines ; the pus is then discharged ex- 
ternally, or into the lung, or pleura, or stomach, &c. 

Treatment. If the bowels are constipated, give a dose 
of Epsom salts to move them. Mustard poultices, followed 
by hot fomentations over the region of the liver, prove ben- 
eficial. If the pain is very severe, six to twelve leeches, 
applied over the seat of pain, may prove serviceable. Lau- 
danum, or some preparation of opium, is indicated to re- 
lieve pain. Dover's powder, in ten or twelve grain doses, 
will prove as beneficial as any form. The diet should consist 
of gruel, milk, and light broths. In all cases active treatment 
is not advisable ; but it is especially so when we infer that 
the formation of matter or suppuration has taken place . 
Nourishing food, as milk, beef tea, or essence of beef, will 
then be required. Tonics, such as quinine (R. 146), or 
quinine and iron (R. 63), or the nitro-muriatic acid 
(R. 148), will also be necessary. The bowels may be reg- 
ulated by Rochelle powders, or the compouud rhubarb pills 
(R. 149). "Warm water injections occasionally prove ser- 
viceable. 

When an abscess has formed, and we are sure that its 
surface is adherent to the abdominal wall, we may — after 
making an exploratory puncture with a grooved needle — 
open it with a lancet, or may puncture it with a trocar ; but 
great judgment and caution must be exercised. None but a 
surgeon should attempt to open it. 

Chronic inflammation of the liver may be the se- 
quel of acute, or it may arise from diseases of the liver, 
such as cancer, tubercles, &c. 

Causes. Intemperance, and the repeated use of alcoholic 



CANCER OF THE LIVER. 141 

liquors, are frequent causes of this disease ; this is more 
especially the case iu hot climates. 

Symptoms. Fulness and weight in the region of the 
liver ; shooting pains felt at times in the same region ; un- 
easiness or pain on pressure ; discomfort from lying on the 
left side ; perhaps some degree of jaundice ; and sometimes 
a certain amount of fever, combining itself with more or 
fewer of these symptoms. 

Treatment. A three-grain blue pill may be given on 
retiring, two or three times a week, for two or three weeks ; 
and on the following morning a Rochelle powder, or a small 
dose of Epsom salts, may be taken. The iodine paint 
(R. 86) may be applied over the region of the liver, once a 
day, for a week or two, with benefit. 

After these measures have been used for two or three 
weeks, they may be omitted, and the following mixture 
taken for a time : — 

Take of Diluted Nitro-muriatic Acid, . £ ounce. 

Pure Water, . . . .1 ounce. 

Fluid Extract of Dandelion, . 1£ ounces. 

Simple Syrup, . . .1 ounce. 

Mix. Shake before using. An adult may take a tea- 
spoonful in a wineglass of water three times a day, before 
meals. 

Persons troubled with any disease of the liver should con- 
sult some regular and reliable physician, as soon as con- 
venient. 

CANCER OF THE LIVER. 

Nearly every variety of cancer has been met with in the 
liver ; encephaloid, or soft cancer, is more common than the 
scifrhus, or hard kind. 

SYMPTOMS. When a liver contains numerous masses of 
cancer, it is generally much enlarged. These masses do 



142 MEDICAL AND SURGICAL COMPANION. 

not give rise to inflammation of the substance of the liver ; 
but when superficial, they often cause some inflammation of 
the adhesive kind, so that after death the tumors are found 
adherent to the diaphragm or to the abdominal walls. The 
remaining symptoms are very obscure ; constant diffused 
pain and tenderness, with disorder of the digestive organs, 
being generally the most prominent. 

Treatment. Our remedies can do little more than pal- 
liate urgent symptoms. Relief to the pain must be given by 
opium in some form, while the digestive organs should be 
strengthened by tonics, and by a light nourishing diet. 



JAUNDICE. {Icterus.) 

This is rather a sign of some affection of the liver than a 
separate disease. 

Causes. It may be produced in two ways: 1st. By 
some impediment to the flow of bile into the intestine, and 
the consequent absorption of the retained bile ; and, 2d. 
By defective secretion on the part of the liver, so that the 
principles of the bile are not separated from the blood. The 
most common impediment to the flow of bile into the intes- 
tine is the impaction of a gallstone in the duct which conveys 
it. Gallstones consist of inspissated bile. Large numbers 
are sometimes found in the gall bladder. Sedentary occupa- 
tions and free living tend to their formation. When the 
obstructing stone has passed into the intestine, it is voided 
with the feces, and the cause of the jaundice being re- 
moved, the skin gradually assumes its natural color. The 
other causes of jaundice from obstructed gall ducts are, can- 
cer of the liver or pancreas, closure of the ducts from ad- 
hesive inflammation of the liver ; by mental shocks, or 
grief, or dissipation ; by certain poisons in the blood, and by 
certain disorders of the stomach. 

Stmptoms. The skin and white portion of the eyes are 



OTHER ORGANIC DISEASES OF THE LIVER. 143 

of a yellow color ; the urine has the tint of saffron ; and 
the feces are whitish, or of a light clay appearance. If the 
disease continue long, there may be stupor, delirium, and 
other indications of cerebral derangement ; the patient also 
becomes weak and thin from mal-nutrition ; and frequently 
there appears to be a tendency to hemorrhage, as bleeding 
from the nose, gums, &c. When there is obstruction from 
a gallstone, the most acute suffering is induced ; the pains 
beiug paroxysmal, and often attended with vomiting and 
hiccup. Should the concretion not pass through the duct, 
fatal exhaustion may set in. 

Treatment. The selection of remedies must, of course, 
be guided by the cause. When the jaundice is due to some 
obstruction, hot poultices, or mustard poultices, warm baths, 
a purgative of Epsom salts, and low diet will be called for ; 
while, during the passage of a gallstone, full doses of 
laudanum — thirty-five to fifty drops — will be necessary, 
either alone or combined with draughts of hot water, to 
every gill of which a teaspoonful of bicarbonate of soda or 
saleratus may be added. On the other hand, the disease 
being due to suppressed secretion, we may cautiously make 
use of the treatment recommended for chronic inflammation 
of the liver. The patient should observe a light but nour- 
ishing diet, take frequent baths, and avoid over-work and 
excessive exercise. 



OTHER ORGANIC DISEASES OF THE LIVER. 

The liver is subject to several organic diseases besides 
those already described — to enlargement, diminution of 
size, hardening, softening ; to fatty degeneration, cirrhosis, 
tubercular deposit, and to all forms of malignant degen- 
eration. 

Fatty degeneration op the liver is of very common 
occurrence in pulmonary consumption, and is commonly 



144 MEDICAL AND SURGICAL COMPANION. 

met with in conjunction with fatty degeneration of the kid- 
ney and other internal organs, in drunkards. It is gener- 
ally, but not always, accompanied by a great increase in 
size, and when once developed, does not admit of cure. 

Cirrhosis, or hob-nail liver, sometimes called gin or whis- 
key liver, is not a very uncommon disease ; and in the vast 
majority of cases is supposed to be due to spirit-drinking. It 
is usually marked by the peculiar granular state of the sur- 
face, the diminished bulk of the organ, and the co-existence 
of abdominal dropsy. 

Malignant degenerations are very apt to occur in the 
liver. They assume the several forms of hard and soft 
caucer, &c, and, like malignant degenerations of other im- 
portant viscera, are necessarily fatal. They generally oc- 
casion a great increase in the size of the organ, and are 
accompanied by obstinate jaundice, and in many cases 
chronic dropsy. 

The treatment of all these organic diseases of the liver is 
palliative, and varies with the symptoms and the existing 
state of the system. 



DISEASES OF THE SPLEEN. 

The spleen, which is situated in the left side, at the end 
of the stomach, may be the seat of inflammation, acute or 
chronic, as well as of simple enlargement, the result of con- 
gestion. But as the symptoms of inflammation of the 
spleen are admitted to be very obscure, it will suffice to 
treat the diseases of this organ under the single head of 



ENLARGEMENT OF THE SPLEEN. 

Causes. Previous attacks of intermittent or fever and 
ague ; morbid degeneration, especially the deposit of tuber- 
cles ; morbid softening, <Sc. 



ENLARGEMENT OE THE SPLEEN. 145 

Symptoms. These are due for the most part to inter- 
ference with the functions of parts submitted to pressure, 
in consequence of the enlargement. They are, dull pain in 
the left side ; hurried breathing ; dry cough ; inability to 
lie on the right side ; depression of spirits ; dyspeptic 
symptoms ; and, in extreme cases, dropsical effusions. This 
disease may be distinguished by the tumor in the left side, 
which, in some cases, becomes quite large ; by the tumor 
being solid and smooth, generally of an oblong shape, lying 
beneath the integuments, and movable. The previous oc- 
currence of ague, or intermittent fever, always affords a prob- 
ability in favor of the tumor being situated in the spleen. 
The term "ague-cake" is sometimes applied to enlarged 
spleen. 

Treatment. The use of iodine paint (R. 86) externally, 
and the iodide of potassium (R. 67) internally. Tonics 
(R. 63 or R. 146) are also sometimes required. Leeches 
may be applied to the seat of the disease if there is much 
abdominal tenderness. Gentle laxatives may be necessary 
to relieve constipation. The diet should be moderate, but 
nourishing. 

10 



146 MEDICAL AND SURGICAL COMPANION. 



CHAPTER IX. 

DISEASES OF THE PERITONEUM, OVA- 
RIAN DROPSY, &c. 

ACUTE PERITONITIS. 

The peritoneum, or membrane which lines the inside of 
the abdomen, may suffer from acute or chronic inflamma- 
tion. 

Symptoms. Acute peritonitis is characterized by paiu, 
at first confined to parts, but afterwards extending over the 
whole abdomen, increased on pressure, and attended with 
high fever. It is sometimes preceded by chilliness and 
rigors, and a feeling of weakness ; in other cases it comes 
on abruptly, Avith acute distress in some part of the abdo- 
men, generally at the lower part. The pain is usually 
very severe, soon spreads over the whole abdomen, and is 
aggravated by any movement which calls the abdominal 
muscles into action, or by pressure, even the weight of the 
bed-clothes being insupportable ; the patient consequently 
lies quiet on his back, with his knees bent and legs drawn 
up. The abdomen is tense, hot, and frequently tympanitic ; 
the bowels are constipated ; there is often nausea and vom- 
iting ; the skin is very hot and dry ; the pulse rapid and 
weak ; the breathing hurried ; the tongue furred ; and the 
countenance is expressive of suffering and great anxiety. 
After a time the belly ceases to be tympanitic, but remains 
somewhat enlarged from the effusion of serum. When a 
fatal termination is approaching, the abdomen often becomes 



DISEASES OF THE PERITONEUM. 147 

much distended, the pulse very quick and weak, the counte- 
nance ghastly, and death occurs from exhaustion. 

Causes. The principal causes are cold and damp, per-, 
foration of the stomach or intestines, the bursting of an 
abscess of the liver, &c. ; it may also arise from inflamma- 
tion of the intestines, from disease of the ovaries, and from 
the contamination of the blood by morbid poisons, especially, 
perhaps, that of erysipelas. 

Puerperal fever, that fearful malady of women recov- 
ering from child-bearing, is very generally accompanied 
by peritonitis. It usually comes on about the third day 
after labor, but sometimes later. The inflammation com- 
mences in the uterine portion of the peritoneum, and spreads 
rapidly over the whole abdomen ; in its symptoms it does 
not differ from common acute peritonitis. It seems to re- 
sult from contamination or poisoning of the blood, either 
by putrefaction of part of the " after-birth " left in the ute- 
rus, or by the absorption of some of the products of inflam- 
mation, or by contagion. 

Treatment. Opium is invaluable in this disease. 
Twenty-five drops of laudanum, or an opium (R. 44) or 
morphine (R. 45) pill should be given, every three or four 
hours, until the pain is thoroughly relieved ; after which the 
dose may be repeated sufficiently often to keep the patient 
from suffering. Oil of turpentine, or spirits of camphor, 
may be gently rubbed over the abdomen two or three times 
a day ; and after each application, hot fomentations should 
be properly and sedulously applied. They give great relief. 
In all cases purgatives do harm. The diet must consist at 
first of gruel ; and cold water or barley water may be al- 
lowed to allay thirst. Should the patient become very low, 
brandy, beef tea, or essence of beef may be given. In some 
cases, quinine (R. 146) may be added to the spirit with 
benefit. Perfect repose of body is very essential. 



148 MEDICAL AND SURGICAL COMPANION. 



CHRONIC PERITONITIS. 

This is sometimes the sequel of the acute, but oftener an 
independent affection. 

Symptoms. These are somewhat obscure, the abdominal 
pain being slight, and the constitutional sufferings variable. 
After a time, effusion of fluid takes place, the abdomen en- 
larges, and fluctuation is felt. 

It is the opinion of some that this disease, when not 
following acute inflammation, is always complicated with 
scrofulous tubercles. 

Treatment. These cases are not very promising ; but 
the patient should partake of a mild but nutritious diet, and 
the iodine paint (R. 8G) or stimulating liuiments (R. 110 or 
111) may be applied to the abdomen. The use of iodine 
(R. 67 or 68) and cod-liver oil (R. 70), internally, will 
often prove beneficial. 

ABDOMINAL DROPSY. {Ascites.) 

Dropsy of the abdomen may arise from chronic perito- 
nitis ; from cirrhosis, cancer, obliteration of the portal vein, 
and scrofulous disease of the liver, causing obstruction to 
the free passage of the blood through the vena portae ; from 
disease aud enlargement of the spleen, and from some 
other disorders. 

The abdomen often becomes very much distended by the 
effused fluid, giving rise to much distress and difficulty in 
breathing. In such cases the operation of " tapping " has 
frequently to be resorted to. In less urgent cases, purgatives, 
and some diuretic, as R. 14, may be taken to reduce the 
quantity of fluid. As a purgative, ten to fifteen grains of 
jalap, combined with a drachm or two of pure cream of 
tartar, will prove beneficial. Tonics and alteratives may 
also be required. Always consult some regular and reliable 
physician in these cases. . 



ABDOMINAL CONSUMPTION. 149 



OVARIAN DROPSY. OVARIAN TUMORS. 

This is quite a common disease, and is sometimes mis- 
taken for abdominal dropsy. The disease may exist for years 
without proving fatal ; sometimes, however, it runs a rapid 
course. 

These tumors sometimes contain a thin, watery fluid, 
which may be drawn off by the process of " tapping." In 
some cases the tumor may, by an operation, be removed 
from the abdomen, and the patient recover. But the opera- 
tion is a very serious one, and should not be resorted to, so 
long as the tumor is not increasing in size, is not affecting 
the patient's health, and is unproductive of any unpleasant 
symptoms beyond those resulting from its weight. When 
such tumors are remaining stationary as regards size, and 
the patient's general health is good, no treatment will, as a 
rule, be beneficial. But if it is poor, alteratives and tonics 
may prove serviceable. Nourishing food, and exercise in 
the open air, will also be required. Always take the ad- 
vice of some reliable physician in these cases. 



ABDOMINAL CONSUMPTION. (Tabes Mesenterica.) 

Abdominal consumption — sometimes termed " consump- 
tion of the bowels " — is a tubercular or scrofulous degen- 
eration of the mesenteric glands. It is confined to no pe- 
riod of life, but is most common in childhood. By far the 
largest proportion of cases occur between the ages of one 
and ten years. In the great majority of cases, the disease 
is associated with tubercular or scrofulous disease in other 
parts of the system. 

Symptoms. Pain in the bowels, more or less constant, 
sometimes severe. The bowels are variable, though gen- 
erally relaxed ; the motions are often unhealthy, and ex- 



150 MEDICAL AND SURGICAL COMPANION. 

tremely fetid. The abdomen is swollen and tense, while 
the other parts of the body waste away, until an extreme 
degree of emaciation exists ; there is great palor and gen- 
eral debility, which increases rapidly. Symptoms of pul- 
monary consumption may supervene, or the patient may 
die, Avorn out by the abdominal disease, unless remission 
takes place. Even in favorable cases recovery is generally 
slow. 

Treatment. The diet should be mild, nourishing, and 
easy of digestion ; and may consist of milk, beef tea, or 
essence of beef, and mutton or chicken broth. Cod-liver 
oil (R. 70), with tonics (R. 63 or 68), will prove beneficial. 
The iodide of potassium (R. 67) sometimes proves service- 
able. Change of air, especially to the sea-side, often does 
great good. 

If the bowels are loose, astringents may be required ; if 
costive, gentle laxatives. 



INFLAMMATION OF THE KIDNEYS. 151 



CHAPTER X. 

DISEASES OF THE KIDNEYS AND 
BLADDER 

INFLAMMATION OF THE KIDNEYS. 

Inflammation of the kidneys may arise without any ap- 
preciable cause, or from cold, from the formation of gravel, 
from various injuries, or from the administration of Spanish 
flies (cantharides), or oil of turpentine. It gives rise to 
neuralgic pains in the loins, especially in the region of the 
kidneys, the pain sometimes extending along the ureters to 
the neck of the bladder, or to the groin, scrotum, or testicle, 
and being increased by pressure, or by exercise ; there is 
often numbness of the thighs ; and, in men, retraction of 
the testicle, with frequent micturition. When this pain 
arises from other causes besides inflammation, as from a 
*' fit of the gravel," — the passage of a small stone from the 
kidney along the ureter to the bladder, — it is termed ne- 
phralgia. In addition to the above symptoms, there is much 
constitutional disturbance, fever, nausea, and vomiting ; 
great thirst ; pulse hard, frequent, and full ; constipation ; 
tympanitis ; and though the desire to pass urine is frequent 
and urgent, yet the secretion is scanty, high-colored, and 
often contains blood. The inflammation may terminate in 
resolution, or, if it continue long, in suppuration ; which 
latter will lead frequently to ulceration, the formation of 
renal fistula, and the establishment of a purulent discharge, 
followed by hectic fever, which often ends fatally. In more 



152 MEDICAL AND SURGICAL COMPANION. 

favorable cases, however, the pus passes out by the natural 
passages, and is found in the urine. Sometimes the disease 
proves fatal at an earlier stage, by inducing coma, owing 
to the retention of urea in the blood, which thus acts as a 
poison. Sometimes, also, typhoid symptoms appear early, 
and death occurs from pure exhaustion. 

Treatment. Give to an adult an ounce or more of 
castor-oil, with twenty-five or thirty drops of laudanum, to 
act upon the bowels. It may be aided, if necessary, by 
warm water injections. The patient may take, as a com- 
mon drink, gum-arabic water, barley-water, or flaxseed tea. 
Hot fomentations, applied perseveringly over the region of 
the kidneys, afford much relief. In severe cases, six to 
twelve leeches may be applied over the same region, after 
which the hot fomentations should be used. The warm hip 
bath often proves serviceable. To relieve the pain, half a 
drachm of laudanum, with two ounces of thin, warm starch- 
water, may be injected iuto the bowels ; and the injection 
repeated every two, three, or four hours, or as ofteu as 
necessary to prevent suffering. In case it is not convenient 
to use the injection, an opium (R. 44) or morphine (R. 45) 
pill, or twenty-five drops of laudanum, may be given every 
two, three, or four hours, or as occasion requires. Perfect 
rest should be enjoined. The catheter should be passed at 
regular intervals, to relieve the bladder, if necessary. The 
diet should be very light, as gruel, arrowroot, and milk. 

This is a grave disease, and the patient should be placed 
under the care of a physician, when possible. 



BRIGHT'S DISEASE. 

(Granular Degeneration of the Kidney.) 

Symptoms. This disease usually comes on gradually and 
imperceptibly, the first marked symptoms being frequent 
passing of water and debility. The patient also complains 



bkight's disease. 153 

of obscure pains in the loins, increased by pressure ; the 
urine is scanty, or increased in quantity, of a cherry-red or 
brown color, or of a muddy appearance, of low specific grav- 
ity, and coagulated more or less by heat and nitric acid ; the 
face is pale, the eyelids often cedematous, the skin dry, and 
there is nausea, with urgent thirst. In this state the patient 
may remain for months, or even for a few years, till at 
leugth some of the secondary disorders make their appear- 
ance. 

Dropsy of the flesh (anasarca) and dropsy of the abdo- 
men or belly (ascites) generally sooner or later appear. 
Complete recovery from this disease is rare, although it may 
occur. 

Causes. Impure air ; intemperance ; mechanical inju- 
ries ; cold ; a previous attack of scarlet fever, followed by 
dropsy, &c. 

Treatment. The patient should abandon all impure or 
intemperate habits, and should take good substantial food, 
with strict regularity ; should keep the skin clean by fre- 
quent bathing, and wear clean and warm clothing ; should 
sleep in dry, airy apartments, and if possible take moderate 
cxcnise in the open air ; and, finally, should be prudent and 
temperate in all things. 

If there is general dropsy, Epsom salts, or the citrate of 
magnesia, to produce free watery discharges from the 
bowels, will prove serviceable. If the dropsical effusion 
be large, a cathartic, composed of ten or fifteen grains of 
jalap and two drachms of bitartrate of potassa, may be given 
every two to four days, to reduce it. 

Diuretics (R. 14, R. 15) are sometimes beneficial. 

The following preparation of iron will do much good in 
nearly all cases : — 

Take of Tincture of Chloride of Iron, . 1 ounce. 
Pure Water, . . . 3 ounces. 

Mix. From half a teaspoonful to a tcaspoonful may be 
taken in a wineglass or more of water three times a day. 



154 MEDICAL AND SURGICAL COMPANION. 

This being a very grave disease, the patient should al- 
ways, when possible, be placed under the care of a good 
physician. 



BLOODY URINE. (Hematuria.) 

Bleeding from the mucous membrane of the urinary pas- 
sages may proceed from the kidneys, bladder, or urethra. 
It is common in the early stages of those forms of kidney 
disease which arise from a morbid state of the blood. It 
may also arise from malignant disease of the kidney or blad- 
der ; from the presence of a stone either in the kidney, ure- 
ter, bladder, or urethra. 

Urine, containing blood, will be found of a dark-red, or 
even black color. When the blood is derived from the kid- 
ney, it is in general equally diffused throughout the whole 
urine ; on the contrary, when derived from the bladder, the 
blood, for the most part, comes away in greater or less 
quantity at the termination of the discharge, the urine hav- 
ing previously flowed off nearly pure. When the blood 
comes away in drops or in a stream, unmixed with urine, 
the urethra is in all probability its source. 

Treatment. This must vary with the circumstances un- 
der which the hemorrhage occurs. When there is malignant 
disease, or a stone present, astringents may be resorted to ; 
the best being the tincture of chloride of iron, which may 
be taken in doses of twenty drops, in a wineglass of water, 
three or four times a day ; or the gallic acid (R. 72) may be 
used instead of the iron. Perfect rest, in the recumbent 
position, should be enjoined. The bowels may be moved, if 
necessary, by castor-oil, and the patient should observe a 
light diet, and take draughts of mucilaginous liquids, as 
flaxseed tea, thick barley-water, or a solution of gum 
arabic. 

Where there is some morbid poison in the blood, or actual 



DIABETES. 155 

kidney disease, hot air baths, simple warm baths, and pur 
gatives, will prove the most effectual, as they promote elimi- 
nation from the skin and bowels, and allow the kidneys to 
rest. Hemorrhage from the urethra may often be checked 
by the application of ice, or by passing a large bougie, and 
leaving it in the passage for some hours. In hemorrhage 
from the bladder, when other means fail, a solution of alum 
or tannin may be injected into that organ, but this can only 
be done safely and properly by a physician. 



DIABETES. 

Diabetes, or diabetes mellitus, is characterized by the 
presence of sugar in the urine. The term diabetes signifies 
simply increased flow of urine, or diuresis ; and this is gen- 
erally a notable feature of the affection now to be considered. 
An excessive flow of urine, devoid of sugar, constitutes an- 
other form of diuresis, which has also been called diabetes, 
and distinguished as diabetes insipidus. 

The quantity of water discharged in this disease is often 
very great, amounting, in some cases, to three or four gal- 
lons in the twenty-four hours. As so much water is thus 
got. rid of by the kidneys, the most prominent effects will be 
great dryness and harshness of the skin, hardness of the 
feces, with constipation ; pain in the loins, coldness of the 
extremities, with burning pain in the hands and feet ; great 
emaciation and debility ; sponginess of the gums ; mental 
depression ; together with a constant feeling of sinking at 
the stomach, inducing a voracious appetite. This disorder 
generally progresses slowly and insidiously, and often ends 
iu, or becomes associated with, pulmonary consumption. 
Iu most cases this disease proves fatal. 

( IaUSEB. Predisposing. — Hereditary predisposition. Ex- 
rihiKj. — Intemperance; distress of mind; cold; drinking 
cold water when the body is heated. 



156 MEDICAL AND SURGICAL COMPANION. 

Treatment. The first point is to regulate the diet, which 
should be nutritious, and as free as possible from everything 
containing sugar or starch. Of all kinds, animal food is the 
best ; and the patient may take his choice of different kinds 
of meat, poultry, game, fish, and eggs. Cabbage, cauli- 
flowers, spinach, water-cresses, and celery may also be al- 
lowed ; but fruit, and especially potatoes, — which contain a 
large quantity of starch, — must be avoided. If bread is 
used, care should be taken that it is well fermented, and 
stale, and it will be better toasted. To allay thirst, a drink 
may be made by adding two drachms of diluted phosphoric 
acid to a pint of water. Weak beef tea, or mutton broth, 
will also often allay thirst better than other kinds of drink. 
Beer, wine, and coffee should be avoided. The clothing^ 
must be warm ; and cold and damp especially avoided. 

Amongst medicinal remedies, opium is the most im- 
portant ; it may be advantageously given in the form of 
Dover's powder, five grains of which may be taken three 
times a day. The hot vapor bath often proves beneficial by 
exciting the skin to action. Some preparation of iron, as 
R. 60, will generally prove serviceable. Cod-liver oil fre- 
quently does good. Persons afflicted with this disease should 
place themselves under the guidance of some regular physi- 
cian. 

IRRITABILITY OF THE BLADDER. 

Irritability of the bladder is said to exist when an indi- 
vidual is troubled with a frequent desire to pass urine. 

Causes. It may arise from organic disease of the kid- 
neys, bladder, prostate gland, or urethra ; or it may be due 
to the pressure of the enlarged uterus during pregnancy, or 
to the irritation of piles. 

Symptoms. The desire to pass water comes on suddenly 
and very frequently, so that in some cases a patient has to 
pass urine every twenty or thirty minutes. There is gen- 



INFLAMMATION OF THE BLADDER. 157 

erally an iuability to resist the desire ; but if this can be 
done, uneasiness and pain are induced by doing so. 

Treatment. Remove the cause or causes of the trouble, 
if possible. Mucilaginous drinks, as gum arabic water, 
flaxseed tea, &c, will prove beneficial. The diet should be 
light and unstimulating, and all alcoholic liquors must be 
avoided. Half a teaspoouful of laudanum, mixed with a 
wineglass of thin warm prepared starch, may be injected 
into the bowels at bedtime, to produce a good night's rest. 
If the case proves obstinate, consult a good physician. 



INFLAMMATION OF THE BLADDER. 

Acute inflammation of the bladder is a severe disease, 
generally confined to a portion of the mucous surface, as the 
neck ; but in severe cases the whole bladder and all its coats 
are attacked. 

Causes. Mechanical injury ; local irritation by stone ; 
the inflammation of* gonorrhoea extending along the urethra ; 
cold ; and all the causes of inflammation. 

Symptoms. Fever ; acute pain, swelling, and tension in 
the region of the bladder ; pain and soreness, increased 
upon pressure, at the lower part of the bowels ; frequent 
inclination to urinate ; painful discharge of urine in small 
quantities, or complete obstruction to its passage ; inclination 
to go to stool ; vomiting. 

Treatment. An opium (R. 44) or morphine (R. 45) 
pill, or twenty-five drops of laudanum, may be given every 
three to six hours, to relieve pain. 

Hot fomentations over the bladder, and warm hip baths, 
will prove beneficial. The bowels may be kept open by 
Bochelle powders. The diet should be very light, with only 
a small quantity of fluids. Our object must be to keep 
the bladder as quiet as possible until the inflammation 
subsides. 



158 MEDICAL AND SURGICAL COMPANION. 



PARALYSIS OF THE BLADDER. 

Symptoms. Retention of urine ; when the bladder is 
over-distended, the patient's water dribbles away by the 
urethra ; the resistance to its escape at the neck of the blad- 
der being overcome when the walls are incapable of further 
dilatation. Hence incontinence of the urine is often a 
symptom of retention. One of the earliest symptoms of 
paralysis of the bladder is pain at the neck of this viscus 
and in the glands penis ; but after a time, little or no un- 
easiness is complained of, and as the bladder loses its sensi- 
bility, even the desire to void urine is not experienced. The 
constitutional disturbance is usually severe ; the pulse be- 
comes quick and feeble, the tongue furred, the appetite fails, 
there is great mental depression, restlessness, and the vital 
powers become greatly lowered. Occasionally the patient 
sinks into a state of stupor, and dies from exhaustion. 

Causes. The paralysis may be due to over-dilatation of 
the muscular coat of the bladder. Thus : a person from 
some cause, as being in the company of ladies, or from be- 
ing so situated as to be unable to void the urine when he 
feels the desire ; on afterwards attempting to do so, he finds 
that he has lost the power. 

It may also be a consequence of apoplexy, or of injuries 
to the head, or of injuries or diseases of the spine. . 

It is, generally speaking, a disease of old age, and seems 
particularly to attack gouty and rheumatic persons. Not 
uncommonly it is connected with disease of the neck of the 
bladder, or with enlargement of the middle lobe of the 
prostate gland. Women who have large families, and 
especially such as have had severe labors, sometimes suffer 
from paralysis of the neck of the bladder ; so that they are 
either unable to retain the urine at all, or it comes away in- 
voluntarily on laughing, coughing, or making any sudden ex- 
ertion. Time, astringent vaginal injections (R. 99 and 



PARALYSIS OF THE BLADDER. 159 

R. 147), cold hip baths, and tonics (R. 59, 60, 63), often 
effect a cure. 

Treatment. Where the paralysis depends upon over 
distention of the bladder, the catheter must be introduced v 
and the urine drawn off gradually, since rapid collapse, fol 
lowed by deatb, has occurred from the too sudden abstrac 
tion of a large quantity of urine. When the paralysis con- 
tinues, the patient should learn to introduce the catheter for 
himself, using as large a one as the passage will allow ; 
and especially should he be careful to always withdraw the 
whole quantity of urine, since that which is retained may, 
after a time, become decomposed, and not only contaminate 
the fresh secretion, as it flows from the ureters, but also 
give rise to most serious changes in the mucous and other 
coats of the bladder. The catheter should be passed about 
every six hours. To restore the contractile power of the 
bladder, galvanism and cold hip baths will do some good. 
The following pills often prove very beneficial : — 

Take of Extract of Nux Vomica, . . 8 grains. 

Extract of Gentian, . . 12 grains. 
Powdered Licorice Root, . . 6 grains. 

Mix, and divide into twelve pills. One may be taken three 
times a day for a week or two. If the case proves obstinate, 
consult a reliable physician as soon as convenient. 



160 MEDICAL AND SURGICAL COMPANION. 



CHAPTER XL 

ON SOME DISEASES OF THE SKIN AND 
HAIR. 

I will treat, in brief, of some of the most common and 
important diseases of the skin, but without makiug any at- 
tempt to classify them, believing it to be unnecessary in a 
work of this kind. 



ERYSIPELAS. ST. ANTHONY'S FIRE. 

Erysipelas is an inflammatory affection of the skin, and 
very commonly of the tissues beneath, characterized by the 
affected part becoming of a deep-red color, hot, painful, and 
swollen. No portion of the surface is exempt from attacks 
of it ; but the integuments of the face and head are most 
commonly the seats of idiopathic erysipelas — that which 
arises from internal causes ; while traumatic erysipelas — 
that which follows wounds, may occur on any part. 

Symptoms. Idiopathic erysipelas resembles the eruptive 
fevers, inasmuch as it is preceded by fever acd general con- 
stitutional disturbance. It often sets in with chilliness, fol- 
lowed by distinct rigors ; sore throat is an early and frequent 
accompaniment of it ; headache, nausea, vomiting, and di- 
arrhoea may also be present. Then, on the second or third 
day from the chill, redness and swelling appear on some 
part of the skin, frequently on one side of the nose, spread- 
ing to the rest of the face, and often extending over the 
scalp, neck, and shoulders. The lips swell, the cheeks en- 



ERYSIPELAS. ST. ANTHONY'S FIRE. 161 

large, the eyes become closed by their puffy lids, and all 
traces of the natural features may be completely lost. After 
three or four days the redness fades, the swelling subsides, 
and the cuticle falls off in the form of scales. In most 
cases the inflammation is merely superficial ; occasionally it 
affects the deeper tissues, when it is termed phlegmonous 
erysipelas, and is then apt to be followed by suppuration — 
formation of matter — and sloughing. 

This disease may prove fatal by the extension of the in- 
flammation to the brain or its membranes, giving rise to 
effusion and coma. The same result may occur from the 
mucous membrane of the glottis becoming affected, so that 
the chink gets closed, and the patient dies unexpectedly from 
suffocation. In other cases, death is owing to failure of the 
vital powers. The larger proportion of those attacked recover. 

Causes. Predisposing. — A full, plethoric habit ; consti- 
tutional peculiarity ; previous affections of the same nature. 
Exciting. — Contagion ; cold ; excessive heat, or vicissitudes 
of temperature ; abuse of fermented liquors ; suppressed 
evacuations ; wounds, or local inflammation of the common 
kind, occurring in certain constitutions, in certain seasons, 
and in places where the disease already exists. It is often 
epidemic, most prevalent in spring and autumn, and fre- 
quently prevails in hospitals, and other crowded situations. 
In all cases, there is a more or less depraved condition of the 
blood. 

Treatment. This must be conducted on the principle 
that we cannot cut short the disease, but only lead it to 
a safe termination. At the commencement, a purgative 
(R. 4, 5, or 6) will be beneficial. After the bowels have 
been well moved, the following mixture may be given : — 

Take of Tincture of Chloride of Iron, . 1 ounce. 
Pure water, .... 3 ounces. 

Mix. One teaspoonful may be taken in a gill of water, 
four times a day. 
11 



162 MEDICAL AND SURGICAL COMPANION. 

Should this noj seem to agree with the patient, R. 43 
may be taken. Of all the local applications which have 
been recommended, the following gives most relief: — 

Take of Poppy Heads, bruised, . . 1 ounce. 
Boiling Water, ... .1 pint. 

Mix, and steep in a covered vessel one hour, and strain. 
Add to the liquid twenty grains of sugar of lead. Flannels 
wrung out of this warm decoction, and assiduously applied 
to the inflamed parts, will do much good. Flour freely 
dusted over the inflamed part has often a soothing, cooling 
effect in mild cases ; but it is apt to form a crust, which ad- 
heres to and irritates the diseased surface. 

In the phlegmonous form of the disease, when suppura- 
tion has taken place, and pus or matter has become infiltrated 
through the areolar tissue, free incisions must be made to 
give it exit. 

In infantile erysipelas the strength must be supported. If 
the mother's milk be deficient in quautity or quality, a vig- 
orous wet-nurse should, if possible, be obtained. Cordials, 
as white-wine whey, wine, or brandy and water, &c, must 
be given. 

ROSEOLA. ROSE-RASH. 

This is a non-contagious inflammation of the skin, char- 
acterized by transient patches of redness, of small size, and 
irregular form, distributed over more or less of the surface 
of the body. The eruption, at first brightly red, gradually 
subsides into a deep roseate hue, and slowly disappears. It 
is accompanied by slight fever. 

Causes. Teething ; irritation of the stomach and bowels ; 
drinking cold water when the body is heated ; severe ex- 
ercise. 

Treatment. Give an adult a dose of Epsom salts to 
move the bowels. Children may take castor-oil, or rhubarb 



NETTLE BASH. 163 

and magnesia. A warm bath often proves serviceable. The 
affection soon disappears. If the patient is debilitated, ton- 
ics will do good. 



NETTLE-RASH. (Urticaria.) 

This is a non-contagious eruption, characterized by long, 
prominent patches or wheals, either red or white, of irreg- 
ular shape, of uncertain duration, and accompanied by in- 
tense heat, a great burning and tingling in the affected spots, 
and great itching. 

There are two varieties : one in which it is acute, running 
a short, rapid course ; another in which it is chronic, very 
obstinate, and either persistent or intermittent. Both forms 
attack individuals of all ages and constitutions. The chronic 
intermittent variety sometimes lasts for months, or even 
years. 

Causes. This complaint is caused by certain derange- 
ments of the digestive organs, arising, in some cases, from 
the use of particular articles of diet, such as shell-fish of 
different kinds, cucumbers, mushrooms, bitter almonds, &c. 
Certain medicines, as turpentine, balsam of copaiba, &c, will 
often cause it. 

Treatment. "Where the disease depends upon stomach 
derangement, an emetic (R. 1 or 2), followed by a purgative 
(R. 4, 5, or 6), will generally remove the trouble. 

To relieve the itching, an alkaline bath (R. 134) will be 
beneficial. In the chronic form, a simple diet, without wine, 
beer, or spirits, must be rigidly adhered to. Laxatives 
(R. 8) and antacids (R. 76, 77) often prove beneficial. 
Tonics (R. 62, 63) will often be required to restore the 
tone of the stomach. 



164 MEDICAL AND SURGICAL COMPANION. 



HERPES. TETTER. 

This is a transient non-contagious affection, consisting of 
clusters of minute vesicles or blisters upon inflamed patches 
of irregular size and form. The eruption runs a definite 
course, rarely continuing for more than two or three weeks ; 
it is not usually severe, nor is it accompanied by any consti- 
tutional symptoms. 

When occurring on the pupace it is liable to be mistaken 
for syphilis. 

Herpes Zoster, Zona, or The Shingles, is very char- 
acteristic in its appearance, position, and course. As the 
name implies, it surrounds the body like a zone or girdle, 
beginning somewhere about the mesian line, and travel- 
ling round one half the body, below the nipple, at the lower 
part of the back and groin, or at the upper part of the 
thigh. It is often preceded for several days, or even longer, 
by very acute, darting pains. It runs a mild course, and dis- 
appears in two or three weeks. 

Herpes Circinatus is arrayed in rings, Avith a red border, 
and a centre of sound skin. It is often called " ringivorm." 

Treatment. Administer a purgative, and regulate the 
diet. As a local application, R. 121 or 123 may be used. 
The trouble will probably disappear in a few days. 



ECZEMA. 

Symptoms. Eczema — sometimes called Running Scall — 
is characterized by an eruption of very small, slightly-raised 
vesicles or blisters, crowded together on broad, irregular 
patches of bright-red skin, accompanied by severe tiugliug 
and smarting. The fluid in the blisters soon becomes 
opaque and turbid, and in four or five days these minute 
blisters burst, the fluid is discharged, and dries into thin. 



PEMPHIGUS. 165 

yellowish-green scabs. Fresh vesicles form on the surround- 
ing skin, while the parts already affected are kept moist by 
constant exudation. "When the eruption is of some stand- 
ing, the skin presents a highly inflamed surface, studded 
with a large number of minute pores, which are covered with 
thin white membranes. 

This disease may be acute or chronic. The usual dura- 
tion of the acute form is from a week to a month. 

Causes. Predisposing.- — The female sex ; the seasons 
of spring and autumn. Exciting. — Intense heat; the 
handling of dry powders, flour, metals, &c. 

Treatment. The bowels should be moved occasionally 
by saline laxatives, as Rochelle powders, or small doses of 
Epsom salts. "Warm baths often prove beneficial. The 
patient should observe a plain, simple diet. As a local 
application, the following preparation will prove service- 
able : — 

Take of Glycerine, . ... 2 ounces. 

Fluid Extract of Opium, . . 2 drachms. 
Rose Water, . . . .14 drachms. 

Mix. Apply two or three times a day. 

A mixture of equal parts of lime water and sweet oil is 
excellent. The benzoated ointment of oxide of zinc may 
often be used with benefit. 

In severe chronic cases, alteratives (R. 67, 68) should be 
tried. 

PEMPHIGUS. 

This disease is characterized by the appearance of large 
bulla?, or blisters, two or three inches in diameter, upon one 
or more regions of the body. The eruption is. generally 
preceded, for twenty-four or forty-eight hours, by slight gen- 
eral indisposition, fever, and itching of the skin ; small, 
red circular patches then form, gradually increase in extent, 



166 MEDICAL AND SURGICAL COMPANION. 

and become covered with blisters, which either fade away 
on attaining their full size, or burst, and are replaced by- 
thin, brownish-colored incrustations. The duration of this 
disease is usually from one to three weeks, although it occa- 
sionally becomes chronic, and prolonged for months. 

Causes. Unwholesome and scanty food, bad ventilation, 
and all the causes of poor blood. 

Treatment. Tonic (R. 60, 62) and alterative (R. 67, 
68) medicines, with generous diet and fresh air, appear to 
be the remedies called for. 



RUPIA. 

This may be considered as a modification of pemphigus, 
occurring in persons of debilitated constitutions, and in those 
whose systems have been contaminated with the poison of 
syphilis. It is characterized by the eruption of small, flat- 
tened blisters, containing at first a serous or watery fluid, 
which soon becomes purulent, and concretes or dries into 
dark, black, rough crusts or scabs. When the scabs fall 
off they leave circular ulcers, of various sizes, indisposed to 
heal. The lower extremities are most frequently affected. 
Its duration varies from two or three weeks to many 
months. 

Treatment. "Warm baths, generous diet, wine, tonics 
(R. 62, 63), and change of air. In syphilitic rupia the 
iodide of potassium (R. 67) will generally effect a cure. 



ECTHYMA. 

This is an acute inflammation of the skin, characterized 
by large, round, prominent pustules, occurring upon any 
part of the body. The pustules are usually distinct, seated 
upon a hard, inflamed base, and terminate in thick, dark- 



IMPETIGO. 167 

colored scabs, which leave superficial ulcers, followed by- 
scars. It is often caused by different stimulating applica- 
tions to the skin, such as lime, salt, sugar, &c. Grocers 
and bricklayers are subject to it. 

Treatment. This must consist in the use of gentle laxa- 
tives, with alteratives, slightly acid drinks, and spare diet. 
The benzoated zinc ointment (R. 123) may be applied to 
the pustules. 

IMPETIGO. 

This is a severe non-contagious inflammation of the skin, 
characterized by an eruption of small hemispheroidal or 
flattened pustules, most frequently grouped in clusters, and 
forming thick, rough, yellowish scabs or incrustations. 
From beneath the incrustations a discharge takes place ; 
the crusts become thicker and larger, and fall off, leaving 
a raw surface. It sometimes occurs on the face ; is attended 
with constitutional disturbance ; and as the pustules burst 
and form scabs, the heat and itching become intolerable. 
In children, this eruption sometimes covers the face like a 
mask, and is called crusta lactea. There is another form 
of the disease, differing from the one just described, inas- 
much as the pustules are more scattered, being sometimes 
distributed over the entire limb, or even over the whole 
body. 

Causes. The application of irritating substances to the 
skin ; unwholesome diet ; impure air ; want of cleanliness. 
It is most liable to occur in spring and autumn ; and chil- 
dren, and persons of a lymphatic temperament, are most 
subject to it. 

Treatment. As a local application, the ointment of ox- 
ide of zinc (R. 123) will prove beneficial. The iodide of 
sulphur ointment is excellent. 

Tonics and gentle laxatives may be used to advantage. 



168 MEDICAL AND SURGICAL COMPANION. 



SCALD HEAD. (Porrigo.) 

Symptoms. Small, round pustules, seated on the hairy 
scalp, and containing a yellow matter, which concretes so as 
to form a hard, prominent scab, presenting a central de- 
pression. The disease generally attacks children, but is not 
confined to young persons. The seat of the disease is the 
hair follicles. 

Treatment. The hair must be cut close with sharp 
scissors, and the scalp be well washed, and the scabs must 
be softened with warm fomentations or poultices. 

The best local application, in the great majority of cases, 
is the iodide of sulphur ointment, which may be applied 
daily for a considerable time. 



TCH. SCABIES. 

This is a contagious disease, — contagions in that sense 
which implies contact, — consisting of a vesicular eruption, 
presenting a number of watery heads, attended with violent 
itching. This affection may attack every part of the body, 
though it most frequently occurs in the flexures of the 
joints, especially on the fingers. The cause of the disease 
is an insect called the Acarus Scabei, which is to be found 
about a line from, but not in, each vesicle. 

Treatment. Kill the insect by the free application of 
sulphur ointment (R. 122), and thus this loathsome disease 
will be cured. The contaminated clothes should be well 
fumigated, or smoked with sulphurous acid gas, — which 
may be procured by igniting a rag dipped in melted sul- 
phur, — after which they must be thoroughly washed. 



LICHEN. ITCHING. 169 



LICHEN. 

This is a papular affection, readily recognized by the mi- 
nute, hard, red elevations of the skin which it presents, 
together with the annoying itching. 

Causes. Predisposing. — The seasons of spring and 
summer. Exciting. — Extreme heat ; irritants applied to 
the skin ; the handling of dry powders ; abuse of ardent 
spirits ; disorders of the stomach and bowels ; and in chil- 
dren, the irritation of teething ; the syphilitic taint. 

Treatment. "Warm baths, mild laxatives, and sour 
drinks will cure most cases of lichen. 

The irritation may be allayed by the following lotion : — 



of Bichloride of Mercury, 


. 6 grains. 


Chloroform, 


. 30 drops. 


Glycerine, 


. 2 ounces. 


Pure Water, 


. 6 ounces. 



Mix. Apply night and morning. 



ITCHING. (Prurigo.) 

This disease is characterized by an eruption of small pim- 
ples, of the natural color of the skin. It is a chronic affec- 
tion, lasting for months or years, and causing great discom- 
fort. The pimples are larger than those of lichen. It may 
occur on any part of the body, but is most common on the 
neck and shoulders. In some instances it attacks the exter- 
nal parts of generation in both sexes, or the verge of the anus. 

The itching arising from prurigo must not be confounded 
with that caused by insects. It may be well to here men- 
tion that the humau body may be infested with three kinds 
of lice ; viz., the clothes louse, head louse, which lives in the 
hair, and the crab louse, which infests the hair of the pubes. 



170 MEDICAL AND SURGICAL COMP ANION. 

They may all be destroyed by cleanliness, a fine-tooth comb, 
and mercurial ointment, or " unguenturn." 

Causes. All causes of debility and cachexia ; friction ; 
irritation of the skin or mucous membrane. It occurs most 
frequently in spring and summer. 

Treatment. The general treatment must consist of a 
light, nourishing diet, the avoidance of stimulating food 
or drink, and the use of sajsaparilla (R. 67) or acid tonics 
(R. 146, 148). 

The following lotion may be used to allay the itching : — 

Take of Sulphate of Zinc, . . .8 grains. 

Glycerine, . ... 2 drachms. 

Rose Water, or Pure Water, . 4 ounces. 

Mix. Apply night and morning. 

In obstinate cases the following may be tried : — 

Take of Bichloride of Mercury, . . 4 grains. 

Glycerine, . ... 2 drachms. 

Water, . . . . .4 ounces. 
Mix. Apply twice a day. 



SCALY LEPROSY. (Lepra Vulgaris.) 

This is, perhaps, the most obstinate and troublesome of all 
diseases of the skin. It is a non-contagious, chronic erup- 
tion, consisting of red, scaly, circular patches, of various 
dimensions, scattered over various parts of the body, but 
more frequently found in the neighborhood of the joiuts, 
especially near the knee and elbow. By degrees the patches 
increase in size and number, and extend along the extremi- 
ties to the trunk. 

Causes, &c. Obscure in many cases. An eruption re- 
sembling this may arise from syphilis. It is termed syphi- 
litic lepra, and is copper-colored. The disease is essentially 



DANDRUFF. 1 71 

chronic," obstinate and difficult of cure, and disappears and 
returns without obvious cause. 

Treatment. The diet must be simple, and all stimulating 
food or drink avoided. 

Preparations of arsenic, iodine, and mercury are used in- 
ternally in the treatment of this disease ; but as these pow- 
erful medicines can hardly be managed with safety by 
non-medical persons, all afflicted with the disease should 
place themselves under the care of some regular physician. 
Alkaline baths (R. 134) and the iodide of sulphur ointment 
may be used with benefit. 



DRY TETTER. SALT RHEUM. (Psoriasis.) 

This is a non-contagious inflammation of the skin, char- 
acterized by the development of patches, of various extent 
and form, slightly raised above the level of the skin, covered 
by thin, whitish scales of altered cuticle, and accompanied 
by fissures of the skin. The eruption may be local, or it 
may be diffused over the whole body. This disease is close- 
ly allied to lepra in its nature and appearance. In lepra 
the patches are irregular, and not depressed in the centre ; in 
psoriasis they are circular, and depressed in the centre, with 
elevated margins. Both affections are sometimes hered- 
itary. 

Treatment. Alteratives and tonics internally. As ex- 
ternal applications, tar ointment, equal parts of glycerine 
and rose water, and many other things, prove beneficial. 



DANDRUFF. (Pityriasis.) 

Symptoms. This disease is a chronic inflammation of the 
skiu, atteuded with redness and itching, and characterized 
by the production of minute white scales or scurf in great 



172 MEDICAL AND SURGICAL COMPANION. 

quantity. It may attack any region ; but the scalp and parts 
covered with hair are the most common seats of it. The 
disease is often very rebellious to treatment. 

Causes. Predisposing. — Youth and old age; female 
sex; debility. Exciting. — Irritation of the skin by heat, 
by the strong rays of the sun, or by chemical or mechanical 
irritants. 

Treatment. Cleanliness ; warm baths ; and tonic and 
alterative medicines. 

As an external application, the following lotion often 
proves very beneficial : — 

Take of Liquor of Potassa, . . 2 drachms. 

Diluted Hydrocyanic Acid, . 1 drachm. 

Glycerine, . . . . 2 ounces. 

Rose Water, . . . . 5£ ounces. 

Mix. Apply to the scalp, or part affected, night and 
morning. 

ACNE. 

This is a chronic pustular affection, characterized by 
small pustules with a deep red base, leaving behind small, 
hard, red tumors. Its primary form is, in most cases, a 
hard, red pimple. It is most commonly seen on the nose, 
cheeks, temples, and forehead, but frequently appears on the 
back and upper part of the chest, and sometimes on the neck 
and shoulders. It may exist in all these situations in the 
same person. It is a chronic disorder, not accompanied by 
constitutional symptoms ; is most frequent from fourteen to 
thirty-five, and occurs in both sexes. 

Causes. Hereditary predisposition ; dyspepsia ; excess 
in eating and drinking ; uterine disorders ; " change of 
life," &c. 

Treatment. Warm baths are beneficial. The iodide 



LUPUS. THE WOLF. 173 

of sulphur ointment, applied night and morning, is excel- 
lent. 

The diet must be restricted, stimulants of all kinds ab- 
stained from, and mild laxatives occasionally employed. 



LUPUS. THE WOLF. 

This is a most formidable affection. It commences with 
purple and red spots, or more frequently livid, indolent tuber- 
cles, the chief character of which is their tendency to end 
in destructive ulceration of the surrounding parts. There 
are two varieties of this disease — lupus non exedens, and 
lupus exedens, or noli me tangere. In the first there is no ul- 
ceration, yet the tubercles leave deep scars behind them ; 
when it spreads rapidly and superficially, it leaves the skin 
crossed by white scar-like ridges and bands. The second 
is very destructive ; it attacks the nose more frequently than 
any other region of the body, though why it does so is un- 
known. The extent of parts which it destroys varies ; 
sometimes the whole nose being eaten away, sometimes only 
the point. 

Causes. Predisposing. — The female sex; the scrofulous 
diathesis. It usually occurs in persons under thirty. Ex- 
citing. — Obscure. It is not contagious. 

Treatment. This is a very serious disease, and should 
always, when possible, receive attention from a physician. 
It generally requires a prolonged course of powerful altera- 
tives. In some cases strong caustic applications have to 
be used to destroy the ulcerated surface, and excite the parts 
to a more healthy action. The iodide of potassium (R. 67) 
internally, and the iodide of sulphur ointment externally, 
may be used to advantage in nearly all cases. 



174 MEDICAL AND SURGICAL COMPANION. 



BARBER'S ITCH. 

Any eruption appearing on the face, and believed to have 
been contracted from a barber's brush, sponge, or towel, is 
denominated by people, Barber's Itch. 

Treatment. In some cases it will be necessary to dis- 
continue shaving for a time. The following wash often 
proves serviceable : — 

Take of Bichloride of Mercury, . . 6 grains. 

Glycerine, , . . . £ ounce. 

Rose Water, . . . . 1£ ounces. 

Mix. Apply two or three times a day. 

If this fails, try the iodide of sulphur ointment. Do not 
be too impatient ; it requires a little time to cure these 
eruptions. 

SYCOSIS. MENTAGRA. 

This affection is limited to that portion of the face on 
which the beard grows — the chin, the cheeks, and the 
upper lip, rarely extending to the integuments immediately 
adjacent. 

Symptoms. Redness, tension, and smarting of the skin 
of the chin, lower jaw, or upper lip, followed by an eruption 
of small, red points, which, in the course of a day or two, 
ripen into distinct pointed pustules, traversed by a single 
hair. After five or six days more the pustules burst, dis- 
charge their contents, and form thin, brown scabs, which 
fall off, and are sometimes not renewed. When the disease 
has continued for some time the beard falls off. In chronic 
cases the skin of the parts is covered with tubercles. This 
is often an obstinate disease. It is alleged to originate in 
a peculiar species of parasitic plant, and to be communicated 
by contagion. 



DISEASES OF THE HAIR. 175 

Treatment. The same as for barbers' itch. Apply to a 
physician. 

ELEPHANTIASIS. BAKBADOES LEG. 

This disease is characterized by great swelling and hard- 
ening of the skin and tissues beneath, producing marked de- 
formity. It frequently attacks the lower extremities, causing 
great swelling, so that the limb becomes, in many cases, more 
than double its natural size. The patient is then said to 
have an " elephant leg." It is not very common in this 
country, occurring principally in the West Indies, being not 
uncommon on the Island of Barbadoes, hence often called 
Barbadoes Leg. It generally continues for life, causing 
more or less constitutional disturbance. 

It attacks both males and females, and the rich and poor 
indiscriminately. 

Causes. Predisposing. — Hereditary taint ; the causes of 
scrofula ; certain climate. Exciting. — Obscure. 

Treatment. Stimulating applications externally, and al- 
teratives and tonics internally. 



DISEASES OF THE HAIR. 

The diseases of the hair consist in alterations of its natu- 
ral color or characters, and in its partial or total loss. 
Some few cases have been recorded in which the hair has 
undergone a sudden change of color, from a light to a dark 
hue, or the reverse, without any apparent cause, or after 
some acute disease ; and not unfrequently, when it is repro- 
duced after it has been removed for some fever, or other 
affection, it grows of a much darker color than it had been 
originally. This is usually the case when it has been kept 
cut close for any length of time in the treatment of any of 
the eruptions of the scalp. 



176 MEDICAL AND SURGICAL COMPANION. 

Loss of color in the hair is one of the natural results of 
old age, but it often occurs at a comparatively early period 
of life, either from constitutional causes, or from extreme 
mental anxiety. The effect of the latter is well marked, 
and some cases have been witnessed in which the hair has 
become perfectly white in the space of a few hours, while 
an individual was laboring under some violent emotion of 
the mind. These demand no other notice here than a mere 
reference. 

The most important of the constitutional causes of gray 
hair is hereditary predisposition ; and examples of prema- 
ture grayncss of the hair, descending through several gene- 
rations, in certain families, are very numerous. 

Blanching of the hatr is sometimes associated with 
debility of the vital powers. It is occasionally witnessed 
in those who die young of consumption, or other lingering 
diseases. 

Treatment. No treatment, local or general, has any 
effect over the forms of grayness arising from age aud he- 
reditary predisposition. 

For blanching of the hair, arising from debility of the 
vital powers, the proper treatment is to restore the system 
to a state of robust health, if practicable, by the use of such 
remedies as may be appropriate for the individual case. 

Should the hair be dry and crisp, and the surface of the 
scalp appear bloodless, R. 143 may be used with benefit. 
Cutting the hair short, or removing it altogether, by shaving 
the scalp, occasionally proves useful. 



BALDNESS. (Alopecia.) 

General baldness is in many persons the accompaniment 
of old age, being usually associated with gray hairs ; nor 
can it be regarded as a disease, except when it occurs in 
comparatively early life. Some few cases of baldness from 



BALDNESS. 177 

birth have been recorded, in which, however, it was due to 
non-development of the hair follicles. 

Permanent baldness is at times the result of some eruptive 
disease of the scalp, especially of porrigo, and is then a con- 
sequence of the inflammatory action which may exist ex- 
tending to the bulbs. After most diseases of the scalp, 
however, although the hair falls out, it is reproduced. Loss 
of hair, partial or general, is also a not unfrequent sequence 
of fevers and acute inflammatory affections, and of syphilis ; 
in the former case it generally grows again, but in the latter 
the baldness is frequently permanent. Loss of hair from 
natural causes, at an early age, is, like the premature change 
of its color to gray, hereditary in the majority of instances, 
is also caused by violent emotions of the mind, or prolonged 
mental anxiety, and is connected, pathologically, in some 
individuals, with general debility, or diminished vital action. 
Baldness existing from birth, and that arising from old age, 
is incurable, as is also that form of it which is hereditary. 
In other cases, repeatedly shaving the head, or keeping any 
hair that may remain cut close for a time, and the applica- 
tion of R. 143, often prove beneficial. 
12 



178 MEDICAL AND SURGICAL COMPANION. 



CHAPTER XII. 
DISEASES OF WOMEN, &c. 

ITCHING OF THE VULVA. (Pruritus of the Vulva.) 

Symptoms. The patient experiences an intolerable itch- 
ing of the vulva, or external parts, and sometimes it extends 
up the vaginal canal. 

Treatment. Wash the parts night and morning, after 
which apply the following lotion : — 

Take of Acetate of Lead, . . .30 grains. 

Liquid Extract of Opium, . 2 drachms. 
Water, 1 pint. 

Mix. If this does not succeed, try the following : — 

Take of Calomel, .... 1 drachm. 

Glycerine, .... 1 ounce. 
Lime Water, . . . .15 ounces. 

Mix. Apply two or three times a day. This disease is 
sometimes a symptom of some other affection, which must 
be cured before this will cease. 

LEUCORRHCEA. WHITES. FLUOR ALBUS. 

This disease is generally the result of inflammation of 
the vaginal canal, and is one of the most common and 
troublesome affections to which women are liable. It may 
be either acute or chronic. 

Symptoms. In the acute form the patient first experiences 



LKUCORRHCEA 179 

a sense of heat, soreness, and fulness in the vagina ; some- 
times accompanied with itching of the external parts. 
These symptoms increase after a time, and pain, smarting, 
a feeling of weight and bearing down are added. If the 
attack be violent, weight in the lower part of the bowels, 
and pain extending down the thighs, may be experienced, 
and the irritation may even be extended to the bladder. 
At first there is no discharge ; but in the course of a clay 
or two, the patient notices a more or less profuse flow of a 
thin, colorless, acid, and, occasionally, acrid fluid, which, 
in a little time, becomes whitish, greenish, or yellowish, and 
of much thicker consistence, and without any diminution in 
the quality, until the attack subsides. 

If the attack is but slight and temporary, no constitutional 
symptoms will be developed ; but if severe, the patient will 
suffer from chills, heaviness, and languor, pain in the back 
and round the loins, headache and thirst, with a quick pulse 
and coated tongue. 

The general symptoms, as well as the local ones, are, 
however, generally mitigated by the establishment of the 
discharge. 

Causes. Cold, violence, excessive sexual indulgence, ex- 
ertion soon after delivery, or inflammation extending inter- 
nally from the external parts, &c. 

Treatment. In severe cases the patient may be con- 
fined to the bed, and the diet should be light. A warm or 
hot hip bath, night and morning, will be advisable, and the 
patient's bowels may be kept free by her taking, every day 
or two, a Rochelle powder, or small dose of Epsom salts. 
Vaginal injections of warm water, three or four times a day, 
and the application of warm fomentatons to the external 
parts, will prove serviceable. When the inflammation has 
somewhat subsided, dissolve one drachm of acetate of lead 
in a pint of warm water, and use as a vaginal injection three 
times a clay. In the majority of instances, an early and 
diligent use of these means will cure the disease ; if not, it 



180 MEDICAL AND SURGICAL COMPANION. 

will probably assume tbe chronic form, which we will next 
consider. 

CHRONIC VAGINAL LEUCORRHCEA. 

This is one of the most common diseases to which females 
are liable, few escaping an attack of it at some period of 
their lives. 

Symptoms. The patient experiences a colorless or whit- 
ish discharge from the vagina. In some cases it is of a 
brownish color, and acrid, excoriating the edges of the ex- 
ternal parts. There is very little increase of heat, and sel- 
dom any pain or tenderness. If the discharge be very 
profuse, considerable weakness may be induced, with great 
weariness after exertion. There is generally some com- 
plaint of aching in the back and loins, and, after the dis- 
charge has continued long, dyspeptic symptoms may ap- 
pear. 

Causes. This form of leucorrhcea is frequently a sequel 
to an acute attack, but may be caused by frequent child- 
bearing, excessive sexual intercourse, ulceration of the neck 
of the womb, displacements, &c. 

Treatment. Remove, if possible, the causes of the dis- 
ease. It is not often that lowering measures are required ; 
but tonics, such as R. 59, 60, or 63 will generally prove 
beneficial. Balsam of copaiba and cubebs often prove bene- 
ficial, and R. 18 or 19 may be tried. But the most power- 
ful remedies are astringent solutions (R. 99, 100), which 
may be thrown up the vagina by means of a syringe or 
clyster-pipe. First, use an injection of simple warm water ; 
after which, the solution. It should be administered slowly, 
and in the recumbent posture, and retained from ten to 
twenty minutes. The injection should be repeated two or 
three times a day. 

UTERINE LEUCORRHCEA. 

"When the discharge originates in the uterus, it is termed 
uterine leucorrhcea. 



INFLAMMATION OF THE UTERUS. 181 

Treatment. In addition to the measures recommended 
for vaginal leucorrhoea, some application to the interior of 
the womb may be necessary ; for which, apply to a compe- 
tent physician. 

infantile leucorrhcea. 

This consists of a whitish or creamy discharge from the 
external parts (vulva) of infants .and older children. It 
usually occurs among the neglected and badly-nursed chil- 
dren of the poor. 

Symptoms. Local uneasiness, itching, and scalding on 
making water ; the external parts are found inflamed and 
swollen, but for some time there is no discharge. After the 
disease has continued for a few days the discharge com- 
mences, and, being of an acrid character, causes the child 
to be very uneasy and restless. 

Treatment. Wash and foment the parts well with warm 
water, milk and water, or poppy-leaf tea, two or three times 
a day, after which apply the following : — 

Take of Acetate of Lead, . . .20 grains. 
Water, . .... 1 pint. 

Mix. Use as a wash ; and if the inflammation have ex- 
tended into the vagina, inject some of it by means of a small 
syringe. The general health and condition of the child 
must be improved ; and for that purpose pure air, cleanli- 
ness, good food, and some preparation of iron (R. 68) 
will be required. 

inflammation of the uterus, etc. 

Of the Neck of the Uterus. — The neck of the uterus 
is liable to congestion, inflammation, ulceration, hardening, 
displacement, &c. 

Causes. Cold, irritation from sexual intercourse, preg- 
nancy, child-bearing, &c. 

Symptoms. At first occasional aching in the back, and 



182 MEDICAL AND SURGICAL COMPANION. 

some mucous discharge. In some cases the pain in the 
back and region of the ovaries is very severe, accompanied 
with a sense of dragging, and extending down the thighs, 
and increased by standing or walking. In almost all cases 
the patient suffers from leucorrhoea (whites), more or less 
profuse. The general health soon becomes impaired, and 
the menstrual function more or less deranged. In these 
cases pregnancy rarely takes place, and sexual desire is en- 
feebled in most cases, and quite destroyed in many ; inter- 
course being often very painful, aud always # occasioning 
increased irritation. 

Treatment. The stage of the disease, and the condition 
of the parts, must determine the remedies to be employed ; 
and as the sufferers cannot learn these facts for themselves, 
they should consult some reliable physician, aud follow his 
instructions. 

The body of the uterus is liable to become the seat of 
inflammation. It may arise from taking cold during the 
menstrual period, violent exertion, blows, &c. 

.Symptoms. Chills, succeeded by feverishness ; occasional 
paroxysms of sharp pain in the back and lower part of the 
bowels, aud darting down the thighs. This afl'ectiou may 
be either acute or chronic. In chronic cases the pain is less 
severe than in the acute form. 

Treatment. Rest, low diet, hot hip baths, and vaginal 
iujectious of warm water, will prove serviceable. Opiates 
may be taken to relieve pain. In some severe cases leeches 
applied to the neck of the womb give great relief; but this 
method should not be attempted except by a physician. 



TUMORS, POLYPUS, AND CANCER. 

Although the womb is liable to these affections, I do not 
deem it advisable, in a work of this kind, to treat at length 
upon them ; for they can only receive proper attention from 
a physician. 



PROLAPSUS UTERI. 183 



DISPLACEMENTS OF THE UTERUS. 

Three kinds of displacements are common ; viz., Prolap- 
sus, Anteversion, and Retroversion. 

PROLAPSUS UTERI, 

Signifies a sinking or falling of the uterus. It may be 
slight or considerable. When it protrudes beyond the vulva 
it is termed procidentia uteri. 

Causes. Heaviness of the uterus itself; hence it often 
occurs, to some extent, in the early stage of pregnancy ; re- 
laxation of the ligaments, and getting up too early after 
confinement ; tight lacing ; dancing, running, or any severe 
muscular exertion ; leucorrhcea, and other exhausting dis- 
charges, coughing, straining, &c. 

Symptoms. In some cases there is little or no suffering, 
■while in others there is pain in the back and groin, extend- 
ing down the thighs to the knees or toes. In some cases 
the patient suffers great distress in standing or walking, and 
in voiding the urine and feces. Pain in passing the urine is 
sometimes present, from the extension of the irritation to the 
bladder. Leucorrhcea is sometimes present, and in other 
cases monorrhagia, or increase of the menstrual flow. The 
stomach and bowels are sympathetically affected ; there is 
loss of appetite, and the tone of both stomach and bowels is 
lost. Patients thus afflicted often become morose and ir- 
ritable. 

In procidentia uteri the patient frequently suffers little or 
no inconvenience, except that arising from the external 
presence of the organ, or its acrid discharges. Iu addition 
to the above symptoms, a per vaginum examination reveals 
the nature of the disease. 

Treatment. In slight cases, rest in a horizontal posi- 
tion, with cold or astringent injections (P. 99 or R. 100), is 
often sufficient. In decided prolapsus, and almost invariably 



184 MEDICAL AND SURGICAL COMPANION. 

in procidentia, mechanical support, by means of pessaries, 
becomes necessary. Bandages and external supporters, 
when they relieve, act by supporting the abdominal muscles 
and those of the back ; hence they may be useful in women 
who have borne many children, and in whom these muscles 
are much relaxed, but they must not be regarded as uterine 
supporters. 

ANTE VERSION OF THE UTERUS. 

By anteversion is understood that form of displacement in 
which the body of the uterus is directed forwards on the 
bladder, while its neck points backwards. Anteflexion is a 
bending of the uterus at the neck, by which the body is 
caused to fall or tip forward. 

Causes. Violent expulsive efforts, either during or after 
emptying the bladder ; accumulation of feces in the rectum, 
falls, blows, obstinate diarrhoea, and pregnancy in its early 
months. 

Treatment. The organ may, in most cases, be readily 
replaced by a physician, if it has not become adherent, by 
hooking down the neck with the forefinger of one hand, 
while the body is elevated by the other. The patient should 
afterwards be kept in bed, on her back, for several days. 
Perhaps many cases may be cured by directing the patient 
to let the bladder fill, and to keep the bowels empty. 

RETROVERSION OF THE UTERUS. 

By this term is understood a falling or tilting backwards, 
either of the body alone or of the entire uterus. When the 
body alone is forced backwards, it is termed retroflexion. 
When the entire organ takes that position it is called retro- 
version. 

Causes. This affection usually occurs in women who 
have borne children, or who are pregnant, and is caused by 
a sudden impulse backwards, either by a distended bladder, 
by long standing, or by a sudden expulsive effort. During 



MENSTRUATION, 185 

the early months of pregnancy the uterus is peculiarly liable 
to this displacement. The accident may also happen from 
falls, shocks, lifting weights, &c. 

Symptoms. Violent bearing down pains, sense of fulness 
and distention about the loins and lower part of the back, 
dragging and tension in the groins, and inability to, or diffi- 
culty in, passing the urine or fe*ces. A per vaginum exam- 
ination reveals the neck of the uterus thrust forwards, while 
the vagina seems to be obstructed by a hard substance, 
which is the body of the uterus turned down. 

Treatment. In some recent and slight cases merely 
emptying the bladder and bowels are sufficient, the uterus 
recovering itself through the contractions of its ligaments. 
Iu more obstinate cases, a physician will remedy the difficulty 
by pressing up the body by one or two fingers in the rectum, 
assisting them, if necessary, by a finger of the other hand in 
the vagina, by which the neck of the womb can be hooked 
down. The after treatment is, rest in a horizontal posture, 
and the avoidance of the distention of the bladder and 
rectum. 

Various forms of pessaries have been recommended for 
these affections ; but I believe they are not so often neces- 
sary as some suppose. 



MENSTRUATION. 

By the term menstruation is understood the " monthly sick- 
ness" to which females are naturally subject, between the 
ages of about fourteen and forty-five. This sickness, from 
its occurring at this regular interval, is called the menses or 
calamcnia, and the female in whom it so takes place is said 
to be " regular." 

The menstrual function ceases at about the age of forty- 
five, and to this period is often applied the terms critical 
period, turn of life, &c. 



186 MEDICAL AND SURGICAL COMPANION. 

During the whole of a woman's menstrual life she is capa- 
ble of bearing children ; after this her reproductive function 
ceases. 

The flow generally returns every twenty-eight days, and 
lasts from four to six. What would be a profuse discharge 
in some, is merely natural iu others, as every woman is a 
law to herself. Most women perhaps have a little pain, and 
some other unpleasant sensations, during their menstrual 
periods ; but when much pain or inconvenience is expe- 
rienced at such times, the function is not properly per- 
formed ; and this brings us to 



MENSTRUAL DISEASES. 

AMENORRHEA. 

By amenorrhcea is understood an absence of the menstrual 
flow. There are two varieties : 1st, when they have never 
appeared ; and 2d, when, having once appeared, they have 
been arrested from any cause. The first may depend upon 
several causes ; viz., congenital malformation, as absence of 
the ovaries, uterus, or vagina, closure of the mouth of the 
uterus, imperforate hymen, &c. When any of these causes 
are supposed to exist, the case should be submitted to some 
regular aud competent physician. If, as often happeus, the 
retention be dependent on constitutional causes, they must 
be removed. If the patient is of full habit, purgatives, low 
diet, and Avarm hip baths will be proper. When the patient 
is debilitated, an opposite plan of treatment must be fol- 
lowed : tonics, as iron (R. 59 or R. 60), a generous diet, 
exercise, warm clothing, hip and foot baths ; always bear- 
ing in mind that the woman is not sick because she does 
not menstruate, but that she does not menstruate because 
she is sick ; or, in other words, that absence of the 
menstrual flow may be merely a symptom of impaired 
health. 



DYSMENORRHCEA. 187 

The second variety, or suppression of menstruation after 
it has once appeared, may occur also in two forms — acute 
and chronic. When arrested during the flow, as by cold, 
emotions, &c, it is acute. When it occurs in consequence 
of the acute, or from gradual failing of health, disease 
of the ovaries, and the "turn of life" it may be termed 
chronic. 

Treatment. In the acute form, if there are much fever 
and headache, a cathartic may be taken, also warm hip 
baths. If the patient suffers much from pain, a proper dose 
of laudanum may be taken to relieve it. 

In the chronic form, the cause must be removed if possi- 
ble ; and, in addition to the measures recommended for the 
acute form, tonics, such as the preparations of iron (R. 60, 
R. 62) will prove beneficial. The tincture of aloes and 
myrrh, taken in one or two drachm doses, daily, to regulate 
the bowels, often proves advantageous. 

DYSMENORRHCEA. 

By dysmenorrhcea is understood painful or difficult men- 
struation. 

Causes. This affection may depend on a faulty condition 
of the system, upon neuralgia of the uterus, or inflamma- 
tion of that organ, or it may depend on mechanical con- 
striction, or stricture of the neck of the uterus. 

Symptoms. The discharge is often scanty, accompanied 
with great pain in the back, loins, fever, &c. ; and there is 
often expelled membranous or shreddy clots. 

Treatment. During the paroxysm, warm hip baths, and 
laudanum, or morphine, to relieve the pain. If the bowels 
are constipated, a mild purgative should be given. Between 
the menstrual periods, the treatment must be such as will 
tend to remove the cause of the trouble. If the patient is 
debilitated, tonics will be serviceable. If the uterus be in 
a state of chronic nflammation, the treatment proper for 
that affection should be pursued. When the difficulty is 



188 MEDICAL AND SURGICAL COMPANION. 

owing to stricture of the neck of the uterus, it must be 
dilated, for which purpose apply to some good physician. 

MENORRHAGIA. 

By Menorrhagia is meant an increase of the menstrual 
flow, either in frequency or in quantity. 

Causes. Nervous and vascular excitements, fevers, in- 
ternal congestions, displacements of the uterus, and approach 
of the critical period. It may also be caused by foreign 
growths in the uterus. 

Treatment. In persons of a full habit, rest, low diet, 
and gentle laxatives are proper during the attack. The fol- 
lowing powders also prove beneficial in most cases : — 

Take of Gallic Acid, . . .2 drachms. 

Powdered Opium, . . .6 grains. 

Mix, and divide into twelve powders. One powder may 
be taken in syrup every fourth hour. 

In debilitated cases, rest, preparations of iron (R. 59, 
60), and nourishing diet, will be required. When the 
hemorrhage occurs about the critical period it often resists 
the ordinary treatment. Under such circumstances the 
following mixture will often prove beneficial : — 

Take of Fluid Extract of Ergot, . . 2 drachms. 

Tincture of Cinnamon, . . 2 drachms. 
Simple Syrup, . . .1 ounce. 

Mix. A teaspoonful may be taken three or four times a 
day. The powders mentioned above will be found beneficial 
in nearly all cases of menorrhagia. 

Astriugent injections (II 100, 147) into the vagina 
often prove serviceable. When menorrhagia is caused by 
displacement of the uterus, that must be rectified ; when 
arising from foreign growths, they will require proper at- 
tention. In all obstinate cases, consult a regular physician 
as soon as convenient. 



PREGNANCY. 189 

VICARIOUS MENSTRUATION. 

In many cases of suppressed menstruation, where the 
monthly effort occurs without the uterine secretion, and 
where the system generally is suffering from the consequent 
plethora or irregular distribution of blood, an attempt is 
made by the natural powers to afford relief by a discharge 
of blood from some other part, generally one which is al- 
ready enfeebled. This is called vicarious menstruation. It 
is recorded to have taken place from the nostrils, lungs, 
gums, bladder, and other parts of the system. 

Treatment. If the attack has commenced without pre- 
vious warning, little or nothing can be done except to watch 
the patient. If the discharge be from the lungs, and is quite 
profuse, the gallic acid and opium powders recommended for 
menorrhagia may be given. A cathartic may also be of 
service. After the attack has passed, efforts should be 
made to restore the menstrual function. 



PREGNANCY. 

By the term pregnancy is understood the state of being 
with child. 

Signs of Pregnancy. — Cessation of the menses, though 
not invariable, is one of the earliest and most certain signs 
of pregnancy. If a woman has previously been regular, is 
in tolerably good health, and knows of no other very evi- 
dent cause of the cessation, this sign will seldom be decep- 
tive. Some women continue to be u regular" during preg- 
nancy, and a suspension of the menses sometimes occurs 
without auy obvious cause ; but these are rare cases, and 
are only exceptions to the general law. 

A fulness, tenderness, and sudden growth of the breasts, 
is a sign of some value when taken in connection with the 
former ; but it is not to be depended upon when considered 



190 MEDICAL AND SURGICAL COMPANION. 

by itself. The color of the areola, or circle around the 
nipple, is perhaps one of the surest signs, except the first. 
Very early in pregnancy the areola grows darker colored, and 
enlarges in circumference ; and there is also noticed an en- 
largement of the follicles situated in it, with a soft and 
moist state of the integuments. 

Quickening is the term applied to the period when the 
motion of the child is first experienced. It usually occurs 
between the fourth and fifth months, and is a sign of some 
value, although females are liable to mistake the movement 
of wind in the bowels, and the spasmodic twitching of the 
abdominal muscles, for the motions of the child. 

Enlargement of the abdomen usually begins to be percepti- 
ble about the end of the second, or beginuing of the third 
month ; before this the abdomen is often flatter than usual. 

Occasional faintness, a shortness of breath, a sense of 
fuluess in the lower part of the abdomen, a bearing down, 
and a dilliculty in voiding urine, frequently occur in the 
early months; but a symptom of much more importance is 
a periodical sickness at the stomach, and vomiting. This 
generally comes on in the morning, on first rising out of 
bed, though it may come ou at any time in the day, and 
is sometimes almost constant. A capricious appetite, long- 
ings, and antipathies, and an unnatural irritability of tem- 
per, are not unfrequeut symptoms, and though of little im- 
portance, separately considered, may strengthen an opinion 
formed from other signs. Although often extremely diffi- 
cult, during the first three or four mouths, to decide 
whether a female is pregnant, as we approach the fifth or 
sixth month, a physician may often, by auscultation, detect 
the beating of the foetal heart, which settles the question. 

But, to briefly recapitulate; — if the menses are sus- 
pended, the breasts enlarge, the areola? grow darker col- 
ored, and there be periodical sickness and retching, there 
will be but little doubt of the existence of pregnancy. 

The duration of pregnancy is about nine calendar months, 
or two hundred and seventy-four days. 



STAGES OF LABOR. 191 



LABOR. 



By this term is understood that process by which the con- 
tents of the pregnant uterus are expelled. The principal 
agent in effecting this process is the uterus itself, assisted, 
however, by the action of the diaphragm and abdominal 
muscles. 

STAGES OP LABOR. 

Labor may be divided into three stages. The first ter- 
minates with the dilatation of the mouth of the womb ; the 
second with the delivery of the child, and the third with the 
expulsion of the placenta, or "•after-birth." The first stage 
is generally the longest and most distressing, both to practi- 
tioner and patient. The pain, although not so great as in 
the second stage, is of a more distressing character, and 
more difficult to bear. The patient is more irritable, un- 
easy, and alarmed as to the result. Nausea and vomiting 
also occur during this stage, and, it is thought, assist in 
effecting it. 

In the second stage, the phenomena that present themselves 
differ essentially from those of the preceding. The pains 
succeed each other with greater frequency, and last longer ; 
they acquire a more expulsive character, and are attended 
with strong bearing down efforts of the abdominal muscles. 
Upon the approach of each pain, the woman seizes hold of 
anything within her reach, and brings the muscles of the 
extremities, back, and abdomen to aid her in the effort. 
These arc commonly called bearing down pains, and continue 
until the child is born. 

The third stage is occupied by the detachment and expul- 
sion of the after-birth ; the period occupied in effecting this 
varies in duration. Sometimes it is expelled with the body 
of the child ; at others, it is retained for some time after. 
Usually, after an interval of ten or fifteen minutes, pains of 
a different character follow ; by which the detachment of 



192 MEDICAL AND SURGICAL COMPANION. 

the placenta is effected, and it is extruded into the vagina. 
By the voluntary efforts of the woman, assisted by the con- 
traction of the vagina, it is usually soon expelled, and the 
labor is completed. 

Presentations, &c. By the term presentation, is understood 
that part of the child which comes first into the world. 
In most cases the head presents, and this is the most desira- 
able presentation ; since with the child in this position, the 
labor is likely to be easy and speedy, and to terminate favor- 
ably to both mother and child. When the breech presents, 
there is always some danger to the child. In cases where a 
hand, or the abdomen, or back presents, turning the child is 
generally necessary before it can be born ; and as non-med- 
ical persons are not qualified to judge in regard to what 
part is presenting, at the commencement of labor, or to 
rectify unnatural presentations when known to exist, some 
regular and reliable physician, if at hand, should always be 
called to take charge of cases of confinement. 

MANAGEMENT OF A LABOR. 

The management of a labor includes all that is done for a 
parturient patient, from the beginning of her pains till the 
uterus is emptied, and the safety of both mother and child 
secured. 

As this book is only intended as a guide for non-medical 
persons, when a physician is not at hand, I will proceed to 
give only such directions as will enable any person of ma- 
ture years, and ordinary intelligence, to properly manage a 
case of natural labor, occurring under such circumstances 
that a physician cannot be called in season. 

During the first stage the patient need not be confined to 
bed, but may be allowed to sit up, or even walk about, if she 
desires it. 

The condition of the bowels should always be early at- 
tended to ; and if they have not been acted upon lately, 
should be unloaded, either by a large warm water injection, 



MANAGEMENT OF A LABOR. 193 

or a good dose of castor-oil. If the bowels have been con- 
stipated for some days, it may be advisable to give both the 
oil and the injection. The patient should be advised to 
empty her bladder as often as she experiences a desire. 
The diet of the patient, when the first stage is protracted, 
should be light and unstimulating, as gruel, milk, &c. There 
should always be in readiness several strong ligatures, or 
pieces of tape, for the cord, a pair of sharp scissors, some 
strong pins, and a " a binder," or broad bandage for the 
female. The bed should also be properly prepared. This 
is best done by spreading a piece of oiled cloth, or a rubber 
blanket, if at hand, upon the mattress, to protect it at the 
point the patient is about to occupy ; over this may be placed 
several blankets or coverlets, folded square, to receive the 
discharges, &c. These latter can be easily removed after 
the labor is completed, without disturbing the patient, leav- 
ing the bed linen beneath unsoiled. 

The second stage is often announced by the rupture of the 
membranes, and discharge of the " waters" As soon as 
this occurs, the patient should retire to her bed. 

The best position for the woman during this stage is on 
her left side, Avith her hips close to the edge of the bed, 
and her knees drawn up towards the abdomen, and separated 
by a pillow or folded blanket. As the head of the child 
emerges into the world, it should be received in the hand 
of the attendant, and the whole body carefully carried for- 
ward, as the pains or contractions of the uterus expel it, and 
not by any means pulled out, in order to relieve the woman 
from pain, and facilitate the delivery. As the child comes 
into the world, care should be taken to observe whether 
the cord is twisted about the neck, and if it is, to disen- 
gage it. 

When the child is entirely born, and breathing is estab- 
lished, or the cord has ceased to beat, it may be separated 
from the mother. To do this, one strong ligature should 
be tightly tied around the cord, about two inches from the 
13 



194 MEDICAL AND SURGICAL COMPANION. 

body of the child, and another about an inch farther on, 
and the cord cut between them. The child may then be 
placed in a warm blanket, and given to an assistant, who 
will proceed to carefully and thoroughly wash it with warm 
water, using a little castile soap. After it is washed, take a 
piece of old linen or cotton, about four inches square, cut a 
round hole in the centre, large enough for the end of the 
cord to pass through ; lay it upon the abdomen of the child, 
and then apply a bandage to the navel, and secure it by a 
piece of thread. Lay the cord upon the abdomen, with its 
cud pointing upwards ; then apply a broad bandage to keep 
it in place. These things being done, the child may be 
dressed, and placed in bed. It is well to put it to the breast 
as soon as the mother is sufficiently rested. It is not only 
useful to the child by supplying it with the early secretion, 
which is laxative, but it is also beneficial to the mother, in- 
asmuch as it excites contraction of the uterus. 

It is customary to give the child a little molasses and 
water, within an hour or two after birth. It will also be 
well to give it a teaspoonful of water occasionally, to pre- 
vent thirst. On the second or third day, milk generally ap- 
pears in the breasts, after which the child may be nursed 
once in two hours duriug the day time, and twice during the 
night. 

After the cord has been tied and cut, the after-birth 
should be looked for ; and if it has been thrown off, remove 
it from the bed into a chamber vessel. But if not already 
expelled, wait a few moments ; and then if not thrown off, 
request the patient to cough, and bear doivn, while you make 
gentle traction upon the cord. These efforts will generally 
prove sufficient. 

Should there be profuse flowing, either before or after the 
removal of the placenta, the nurse or attendant may place 
one hand in cold water for a moment, and then, with the 
same hand, grasp, and rather firmly compress the uterus, 
which may be detected at the lower part of the abdomen, 



MISCARRIAGE. ABORTION. 195 

seeming like a large ball, about the size of a child's head. 
And, if at hand, half a drachm to a drachm of the fluid extract 
of ergot may be given at once. Soon after the expulsion 
of the placenta, the wet sheets, &c, may be removed from 
under the patient, and dry ones substituted. The " binder" 
should now be applied, and the patient covered over to pre- 
vent chilliness, and left to have an hour's rest, after which 
she may be made comfortable in bed. A dry, warm nap- 
kin should be placed to the vulva, and be frequently 
changed. After labor, a woman should keep her bed ten 
to fifteen days. 

The lochia is the name given to the discharge that con- 
tinues after labor is completed. For some days it retains 
the character of blood ; but it finally loses its firmer propor- 
tions and red globules, and becomes of a greenish tint. It 
usually lasts three weeks, though sometimes longer. Ou 
the second or third day after .confinement, the woman may 
take a dose of castor-oil, or a Rochelle powder, unless her 
bowels move spontaneously. Everything about the patient 
should be kept clean, and be frequently changed. 



MISCARRIAGE. ABORTION. 

When the foetus is expelled before it is capable of main- 
taining an independent existence, — that is, before the sev- 
enth month, — it is called abortion or miscarriage. When 
the expulsion of the contents of the uterus takes place be- 
fore the full term of pregnancy has expired, but after the 
seventh month, it is termed premature labor. 

Causes. Mental emotions, fright, anger, joy, or sorrow, 
when excessive ; intense pain, shocks, blows, falls, great 
fatigue, immoderate sexual indulgence, deficient nourish- 
ment, debilitating evacuations, acute and chronic disease ; 
measles, scarlet fever, small pox, syphilis, &c. To these 



196 MEDICAL AND SCTRGICAL COMPANION. 

we may add a peculiar constitutional irritability of some 
females, by which they abort habitually. 

Symptoms. The patient who is about to miscarry, gen- 
erally experiences a sense of uneasiness, languor, pain in 
the back, and lower part of the abdomen, accompanied by 
pains of an expulsive character, and often with flowing or 
hemorrhage. When the ovum itself is ruptured, there is a 
discharge of water from the vagina, greater or less, accord- 
ing to the age of the fcetus, followed a/terwards by pain and 
discharge of blood. Sometimes the ovum is expelled with 
little or no pain ; at others the pains are described as being 
more severe than those of labor at the full term. 

Treatment. There are two points to be observed in the 
treatment of these accidents ; first, if possible, to prevent 
the expulsion of the fcetus, and enable the woman to com- 
plete her pregnancy ; secondly, where this is hopeless, to 
shorten the process as much as possible, and prevent further 
hemorrhage. As we cannot be certain in the first iustance 
whether the child is dead or not, we must act under the 
supposition of its life, knowing that if the vital relation be- 
tween the ovum and the uterus is compromised it will be 
discharged. 

The preventive treatment will consist in rest, in a strictly 
horizontal posture, on a hard bed, lightly covered with 
clothes, and in a cool room ; cold wet napkins to the vulva, 
light diet, abstinence from stimulants, and the administration 
of an opiate and astringent. 

The following powders will generally prove as beneficial 
as anything : — 

Take of Gallic Acid, .... 2 drachms. 
Powdered Opium, . . .12 grains. 

Mix, and divide into twelve powders. One may be taken 
in molasses or syrup, two or three times a day, for two to 
four days. 



TREATMENT OF ABORTION. 197 

If these means fail, and the hemorrhage or flowing con- 
tinues, whilst the ovum is not expelled, there is little or no 
chance of preventing miscarriage ; and our endeavors must 
be directed to the suppression of the discharge, knowing it 
will generally cease as soon as the womb is emptied. The 
best agent to be used under these circumstances is the 
tampon or plug. By this the reader will understand that 
small square pieces of linen are to be crowded into the 
vagina until that cavity is entirely filled, the whole being 
retained by a T bandage. The plug should be allowed to 
remain from six to twelve, or even twenty-four hours, the 
patient being still in a horizontal position, and the bladder, 
if necessary, relieved by a catheter. When withdrawn, the 
ovum, or fragments of it, will generally be found adherent 
to its upper part, along with a coagulum. 

It must be remembered, however, that the tampon should 
never be used if internal bleeding can take place to such an 
extent as to destroy life ; in other words, not if the uterus 
be empty, and the patient far advanced in pregnancy. The 
plug, it will also be remembered, is not to be used under any 
circumstances where there is a hope of saving the preg- 
nancy. If the ovum is not discharged with the tampon, 
and cannot be reached and hooked down with the finger, 
half a teaspoonful of fluid extract of ergot, given two cTr 
three times during the day, may cause its expulsion. 

Women should observe the same rest and care after a 
miscarriage, as after a labor at the full term ; if they do not, 
serious trouble may follow. When the abortion is habitual, 
and the uterus is irritable, an opiate injection may be ad- 
ministered every night, for a week or longer ; consisting of 
forty-five drops of laudanum, in a wineglassful of warm 
starch-water. Rest, in the horizontal position, should also 
be observed until the inclination to abort has ceased. 



198 MEDICAL AND SURGICAL COMPANION. 



PHLEGMASIA DOLENS. MILK LEG. 

This affection is quite common after confinement, espe- 
cially in women who have been much weakened by flooding, 
or other causes. It is supposed by some to depend upon the 
arrest, from some cause, of the circulation of the blood in 
the femoral vein. 

Symptoms. It usually commences, in from one to five 
weeks after labor, with fever, headache, thirst, nausea, and 
pain ; swelling, and loss of motor power of one of the lower 
extremities, — rarely both limbs are affected, — the swelling 
beginning at the upper part of the thigh, and gradually ex- 
tending downwards. The limb is unnaturally hot, tender, not 
oedematous, but swollen sometimes to twice its natural size ; 
it is of a pale-white color, and has a glazed or shining ap- 
pearance. The acute stage generally lasts from fourteen to 
twenty-one days, but the limb often remains swollen and 
feeble, or almost useless for many weeks, or even months. 

Treatment. This should consist of perfect rest, low 
diet, warm fomentations to the part, and laudanum or 
morphine to relieve pain. After the acute symptoms have 
subsided, alteratives, tonics, and a generous diet will be 
required. Blisters, stimulating liniments, and bandages to 
the limb, may also be useful. 



FOOD OF INFANTS. 199 



CHAPTER XIII. 

MANAGEMENT AND DISEASES OF 
INFANCY AND CHILDHOOD. 

FOOD OF INFANTS. 

There can be no doubt that milk, and milk alone, is the 
proper aliment for infants during the first few months after 
birth ; and that, in all cases where it is possible, this nour- 
ishment should be afforded by the mother herself. As re- 
gards the time after delivery at which the child should be 
first presented to the breast, physicians differ ; some thinking 
that ten or twelve hours should elapse, so that the mother 
may recover from her fatigue ; others, that no time should 
be lost after the infant is dressed, and the mother made dry 
and comfortable. The latter is the plan which I adopt in 
my own practice ; for, without considering whether such a 
proceeding is advantageous — it certainly is not injurious — 
to the infant, I am quite positive that it is of great benefit to 
the mother ; inasmuch as the early sucking of the child not 
only gives a proper form to the nipple and facilitates the 
flow of milk, but the irritation of the breasts tends to cause 
contraction of the uterus, and thus to materially diminish the 
risk of secondary flowing. 

Unfortunately, however, not every mother is capable of 
suckling her infant ; and the question arises, How are we to 
tell when such is the case ? The chief conditions which dis- 
qualify a mother for the office of nurse are, an extremely 
sensitive and excitable temperament, severe constitutional 
deterioration from any cause, a strong predisposition, either 



200 MEDICAL AND SURGICAL COMPANION. 

hereditary or acquired, to scrofula, consumption, cancer, 
syphilis, epilepsy, or insanity, and the existence of any 
severe disease, as puerperal mania, puerperal fever, &c. In 
addition to these circumstances, the mother may be prevent- 
ed from fulfilling her duties, owing to the secretion of milk 
being so scanty as to be almost useless ; or the secretion 
may be abundant, but it may be poor and watery, and 
deficient in milk globules ; or, lastly, the nipples may be so 
flattened and buried in the breasts, that they cannot be laid 
hold of. 

Supposing, then, that the mother is rendered incapable, 
from any of these causes, of performing the duty which 
naturally devolves upon her, the infant must either be reared 
by a wet-nurse, or be " brought up by hand." The princi- 
pal requisites for a good wet-nurse are, that she be between 
twenty and thirty years of age ; of active and temperate 
habits ; of a robust and healthy constitution ; of a quiet, 
patient, cheerful disposition ; exempt from any scrofulous or 
syphilitic taint ; complexion fresh and clear, and skin free 
from eruptions ; gums red and firm, teeth sound, tongue 
clean, and breath sweet ; breasts firm and well-formed, with 
well-developed nipples ; milk abundaut, rather thin, of a 
bluish-white color, sweet, and throwing up plenty of cream 
when allowed to stand ; and lastly, it will be well if the 
date of her labor does not differ materially from that of the 
parent whose place she is to fill. In order to keep the wet- 
nurse in good health, she must live regularly on simple, 
nourishing, and digestible food, and much in the way she 
has been accustomed to ; she must be scrupulously attentive 
to cleanliness, and she should daily take moderate exercise 
in the open air. 

In cases where the mother is unable to nourish the infant, 
and a wet-nurse cannot be procured, our only resource is to 
rear the child by careful artificial feeding. The food usually 
resorted to is the milk of the cow, as it is less expensive 
and more readily procured than the milk of any other ani- 



WEANING. 201 

mal. It differs from human milk in containing less of the 
oleaginous and saccharine principles, but more of the albu- 
minous ; hence it should be slightly sweetened with white 
sugar, and diluted with one third part of plain water. It 
should be about blood warm, and administered by means of 
a feeding bottle, having a nipple formed of vulcanized rub- 
ber, or of a calf's teat. 

Whether the infant be reared by the mother, or by a wet- 
nurse, or by artificial feeding, it should be kept entirely, if 
possible, to the food first chosen, until after the seventh or 
eighth month, when the teeth begin to appear. It should 
also be regularly nursed or fed, during the first two or three 
weeks of life, about every two hours through the day, and 
every three or four hours during the night ; the intervals 
being gradually increased until they reach three or four 
hours in the day, and six or eight at night. Thus the nurse 
will be refreshed, and her patience and moral strength re- 
cruited, by some hours of uninterrupted sleep ; which is 
with difficulty obtained by those who have once got into the 
habit of offering the child the breast whenever it cries, or 
shows any appearance of uneasiness. 

As regards the quantity of milk which the infant requires 
each time it is nursed, it can only be roughly stated that it 
varies from two to six or seven ounces ; less than the former 
being insufficient for the purposes of nutrition, while more 
than the latter will probably induce vomiting. 



WEANING. 

The proper time for weaning healthy children is when 
they are about one year old, when nature — by providing 
teeth, and increasiug the development and muscularity of 
the stomach — indicates that a more solid diet is required. 
The change, however, is not to be made abruptly ; and 
hence, when the first teeth begin to appear, at the end of the 



202 MEDICAL AND SURGICAL COMPANION. 

seventh or eighth mouth, a little supplementary food may be 
very gradually allowed, — such as pure, undiluted cow's 
milk, thin arrowroot, well-boiled gruel, or beef tea, — while, 
at the same time, the quantity of nourishment derived from 
the mother is slowly diminished. The infant will thus daily 
become reconciled to the almost imperceptible alteration in 
its diet ; while the mother's lacteal secretion will by degrees 
diminish, as the demand for it lessens, until it ceases entire- 
ly by the time the child is one year old. There are, of 
course, some cases of delicate children where weaning may 
be well delayed for two, three, or four months after the 
proper time, provided the mother's health continues perfect ; 
but if the latter begins to fail, or the supply of milk to dimin- 
ish, nursing must be abandoned. 

For some time after weaning, the principal nourishment 
should consist of semi-fluid substances ; for it must be re- 
membered that the digestive organs are still weak, and that 
the stomach is easily oppressed and disordered. Of the 
various kinds of food in daily use, the best are arrowroot, 
made with milk and water ; thin gruel, made from groats or 
prepared barley, strained and sweetened ; or sago, thor- 
oughly boiled in weak beef tea, with the addition of a little 
milk. 

As the child grows older and cuts all its first teeth, the 
diet must be further extended; and bread and milk, nourish- 
ing broths, light puddings, eggs lightly boiled, well-cooked 
vegetables, and white fish, and fresh animal food — especial- 
ly chicken or mutton — may be judiciously allowed. Fresh, 
ripe fruit, in moderation, should be given ; plain, light 
pastry, simple cakes, and biscuits seldom do any harm ; 
while the child's notorious love of sugar may be judiciously 
indulged, unless flatulence or acidity arise. But candy, 
colored with poisonous substances, must be avoided. As a 
general rule, too, tea and coffee, wine and beer, should be 
interdicted ; milk, or sweetened milk and water, and pure 
spring water, being much more wholesome. 



CLEANLINESS AND CLOTHING. 203 



CLEANLINESS AND CLOTHING. 

Cleanliness is of the utmost importance to health at every 
period of life, but especially so during infancy and child- 
hood ; for if the manifold and important functions of the 
skin be then imperfectly performed, general constitutional 
disturbance quickly ensues. Hence every care must be 
taken, by frequent and thorough washings, gentle rubbing, 
and clean, soft clothing, to maintain the healthy action of 
the skin. 

The safest and most convenient way of washing the 
infant is to immerse its body in a tub or basin of warm 
water, while the head is supported by the hand and arm of 
the nurse ; at the same time, the whole surface of the body 
— especially about the scalp, joints, and folds of the skin — 
is to be well rubbed with a soft sponge, with or without castile 
soap, so as to remove all offensive matters. Children, when 
they enter the world, are sometimes covered with a lardy 
substance, requiring a little sweet oil to be rubbed upon the 
part, to soften it, before it can be easily washed off. After 
having been in the water for a few minutes, the child is to 
be taken out, quickly and thoroughly dried, and to have 
well-aired clothing at once put on. This bath must be used 
daily, the best time for it being in the morning, as soon as 
the infant is taken out of its bed to be dressed for the day. 
The water should be comfortably warm. The practice of 
using cold water for young infants is quite indefensible, as it 
is well known to have given rise to serious ill effects. Dur- 
ing the first few days of life, care must be taken not to dis- 
turb the remains of the umbilical cord during washing. In 
ordinary cases it dries up and falls off between the fifth and 
seventh days, leaving a small ulceration at the navel, which 
quickly heals. 

Another important element of cleanliness during infancy, 
is the speedy removal of all the damp and soiled clothing, 



204 MEDICAL AND SURGICAL COMPANION. 

which results from the frequent and involuntary discharges 
from the bladder and bowels. At the same time also the 
nates and groins are to be well washed with warm water, 
gently dried, and lightly dusted with finely-powdered starch, 
or oxide of zinc. The clothing of infants and children — let 
physicians say what they may — will always be modified by 
fashion and the various caprices of parents ; but so long as 
it is loose, simple, scrupulously clean, warm, soft, capable 
of being fastened without the use of pins, and not too heavy, 
we need not be very particular as to its shape. The long 
flowing clothes, in which infants are generally dressed for 
the first five or six months, seem at first sight rather absurd ; 
but without doing any harm, they certainly protect the legs 
and feet, and lower parts of the body, from cold air and 
draughts. 

With regard to the material, some allowance must be 
made for the season of the year ; but I think that, as a rule, 
flannel is preferable to any other. In all cases the night- 
clothes are to be looser and less warm than those of the day ; 
moreover, every article should be changed before putting 
the infant to rest in the evening. A cap is seldom required, 
especially indoors ; but if one is worn, it should be thin and 
light. The maxim which says, " Keep the head cool and 
the feet warm," should be borne in mind. 

As children grow older, it is often thought necessary to 
strengthen or harden them, by exposing them unnecessa- 
rily to cold, and putting them into very short, thin clothes, 
with light drawers, bare necks and arms, &c. This is a 
great mistake, however, as all must acknowledge who re- 
member that the power of resisting cold in early life is 
very feeble. Hence, we should always see that the dress be 
warm, large enough, and long enough to clothe the whole 
person, including the chest, neck, upper and lower extremi- 
ties ; and sufficiently loose to allow of perfect freedom of 
motion. There are some robust children, whose constitu- 
tional powers will enable them to bear up against the hard- 



EXEKCISE AND SLEEP. 205 

ening system, with all its cruelty ; but such are not to be 
brought forward in favor of its beneficial effects. They have 
grown up healthy in spite of the treatment, not in conse- 
quence of it. The hardening treatment proves fatal to thou- 
sands yearly. 



EXERCISE AND SLEEP. 

Before the fifth month few infants acquire sufficient 
strength to support the back in an upright position, so that, 
until then, they should be carried about in a reclining pos- 
ture on the nurse's arm, in such a way as to afford entire 
support to the body and head. At this period their bones 
and limbs are very delicate, so that they must not be shaken 
about roughly, nor tossed in the air, nor rocked too violently. 
As they grow older they begin to make efforts to raise them- 
selves ; and seem to experience satisfaction from being occa- 
sionally placed in a sitting position, or from being laid on 
a bed, or on the ground, and allowed to roll and kick about 
at their pleasure. These movements not only afford amuse- 
ment, but they act very beneficially by calling the numerous 
muscles of the body into action, and so increasing their 
strength and bulk. Towards the end of the ninth or tenth 
month most infants may be taught to crawl or " creep " about 
on their hands and feet ; and a few months later, unless very 
feeble, attempts may be made to teach them to walk, by sup- 
porting them under the arms, guarding them against falls, 
and encouraging them to move from one chair to another. 
They should not, however, at this period, be kept too much 
or too long on their feet at one time, as thereby " bow-legs " 
may be induced. We need not wait, however, for infants 
to be able to walk before exposing them to the wholesome 
and invigorating influence of the open air ; for, after the first 
three or four weeks, their health will be much improved by 
their being carried out daily, for one or two hours, when 



206 MEDICAL AND SURGICAL COMPANION. 

the weather is' favorable. The fresh air will be as benefi- 
cial to the nurse as to the child, and both should go out as 
much as the weather and season will permit. When the 
child has fully acquired the power of walking alone, he 
should be allowed the most perfect freedom of exercise, 
especially in the open air during the middle of the day. I 
need hardly say that in the winter and spring months pre- 
cautions will be necessary to avoid " colds ;" but, if undue 
exposure to bad weather be guarded against, if the nurse 
walk quickly, and if the children are suitably clad in warm, 
well-made clothing, there will be but little risk. At a later 
period, active games in the field, by exercising the limbs and 
exposing the body to the invigoratiug influence of solar light, 
promote the growth and regular development of the whole 
frame, and pai-ents should provide opportunity for such 
amusements, by furnishing proper toys — as balls, hoops, 
kites, &c. 

With respect to the quantity of exercise to be allowed, no 
general rule can be laid down, other than that the dictates of 
nature should be followed ; and that when fatigue is experi- 
enced, rest should be allowed. Young infants require a 
great deal of repose — the first few weeks after birth being 
passed almost entirely in sleep, with the exception of the 
time occupied in satisfying the instinctive calls for food. As 
they gradually grow older, however, and as the strength in- 
creases, the periods of wakefulness grow longer ; although 
it must always be remembered that throughout the whole 
period of childhood more sleep is repuired than in adult 
age. To permit of this, children should be put to bed early 
in the evening, so that they may enjoy a deep slumber for 
ten or twelve hours ; while, until they are three to five 
years old, they must be allowed to recruit their strength 
by reposing for an hour or two in the middle of the day, 
before or after dinner. In awaking a child, care should be 
taken to do so gradually and gently, otherwise much injuri- 
ous excitement may be produced. 



DENTITION OR TEETHING. 207 

A young infant requires a warm, soft couch for its repose, 
•with sufficient covering to protect it from the least impres- 
sion of cold. During the first few weeks, it may be advan- 
tageous for it to sleep in the same bed with its mother, espe- 
cially if the weather be cold ; but after this time, a cradle 
or cot should be used. Nothing is more distressing to an 
anxious mother, or more annoying to an impatient nurse, 
than sleeplessness in her infant charge ; and the temptation 
is great to fall into the baneful habit of resorting to lauda- 
num, paregoric, soothing syrups, and quack cordials, to force 
sleep. In the majority of cases we may be certain that 
when a healthy infant does not sleep, either its clothing is 
uncomfortable, or it is cold, or a pain from some removable 
cause, — as the point of a pin being in contact with its 
body, — or it has been over-fed, or fed on some improper 
food. If the removal of the cause does not suflice to 
induce sleep, a warm bath, of a few minutes' duration, will 
never fail to soothe, and will generally cause the child to 
sleep. 

DENTITION OR TEETHING. 

When a child is about seven months old, the two central 
temporary teeth of the lower jaw make their appearance 
through the gum ; being followed, in a week or two, by 
the corresponding teeth of the upper jaw. These are the 
central incisors. In a month or six weeks after the erup- 
tion of the central incisors, we may expect the lateral inci- 
sors to make their appearance ; those of the upper jaw being 
evolved first. About the twelfth or fourteenth month, the 
anterior, or front molar or double teeth, of the under jaw are 
cut, and shortly afterwards those of the upper jaw. The 
cuspids (eye and stomach teeth) appear between the six- 
teenth and twentieth, and between the twentieth and thirti- 
eth the second milk molars pass through the gum. Thus, 
according to this statement, the twenty milk teeth are com- 



208 MEDICAL AND SURGICAL COMPANION. 

plete by the thirtieth month. From this it will be seen that 
the temporary, deciduous or milk teeth, are twenty in num- 
ber, — four incisors, two cuspids, and four molars in each 
jaw : and that they are not all cut until the end of the thirti- 
eth month, or even later, the whole period during which they 
are being gradually evolved being known as that of the first 
dentition. 

ERUPTION OF PERMANENT TEETH. 

After the completion of the first dentition, at the end of 
the thirtieth month, there seems to be a pause, until between 
the sixth and seventh years, when, as stronger organs of 
mastication are needed, the second or permanent teeth begin 
to make their appearance. Tbe periods of eruption of the 
second set of teeth, though liable to some variation, are 
about as follows : The anterior true molars at six and a half 
years of age ; the central and lateral incisors at eight ; the 
anterior and posterior bicuspids at nine and ten ; the cuspids 
(" eye and stomach teeth ") from eleven to twelve ; the sec- 
ond true molars from twelve to thirteen, and the molars, or 
" wisdom teeth," from seventeen to twenty. The teeth of the 
lower jaw generally appear earlier, by four or six weeks, 
thau those of the upper. Any irregularity in the time of 
appearance of the permanent teeth need give rise to no 
anxiety. 

Thus we see that when the permanent teeth are all devel- 
oped, there are sixteen in each jaw, viz., four incisors, two 
cuspids, four bicuspids, and six molars. 



DISORDERS OF THE FIRST DENTITION. 

Perfectly healthy infants, in whom the powers of life are 
energetic, may cut their teeth without any perceptible dis- 
order ; but in the majority of cases there is not only some 



DISORDERS OF THE FIRST DENTITION. 209 

local irritation, but a greater or less amount of general dis- 
turbance. The following is the usual course : Before the 
tooth appears through the guru, the latter is found hot and 
swollen ; there is an increased flow of saliva ; the cheeks 
frequently become flushed ; the child is restless, capricious, 
and fretful, and constantly thrusting its fingers, or any hard 
substance it can obtain, into the mouth, in order to allay the 
excitement and irritation of the gums ; the sleep at night is 
broken and disturbed ; the appetite fails ; and there are 
symptoms of intestinal disturbance, as evidenced by attacks 
of vomiting and diarrhoea. In more unfavorable cases, the 
general disturbance is greater ; the restlessness being ex- 
treme, the skin hot and dry, the mouth parched, and often 
covered with aphthse, or canker ; the tongue foul, and the 
appetite very bad ; so that the child either refuses the breast, 
or takes it only for a minute or two at a time, and at irreg- 
ular intervals. Unfortunately, too, the process may become 
complicated by the occurrence of some important sympa- 
thetic affection, or of some independent disease. It can 
readily be imagined that, in the excited condition of the 
system arising fz'om teething, acute or chronic inflammation 
may attack any organ in the body ; and such is really the 
case, inflammatory diseases of the brain and nervous system, 
and of the organs of respiration, being by no means uncom- 
mon. Severe bowel complaints are also, at this time, rife ; 
diseases of the skin are not unfrequent ; and spasmodic 
affections — varying from mere twitchings of the muscles, 
or sudden startings during sleep, to severe epileptic con- 
vulsions — often justly give rise to great alarm in the minds 
of the parents. 

Any local obstacle to the progress of dental development, 
such as may arise from induration, or from inflammation of 
the gums, or from any disproportion between the size of the 
jaws and the form and number of the teeth, greatly aug- 
ments the constitutional disturbance. Occasionally, in debil- 
itated subjects, the summit of the gum over a tooth, or the 
14 



210 MEDICAL AND SURGICAL COMPANION. 

edge of a gum when partly pierced by a tooth, becomes the 
seat of very painful inflammation and ulceration. The pain 
of this inflammation is sometimes so severe, and tends so 
strongly to augment the fever and general disturbance, {hat 
the child's life may be endangered, and even lost, without 
the most judicious treatment. 

With respect to the eruptions upon the skin connected 
with teething, it need only be mentioned, that they often seem 
to give relief rather than to do harm, and hence they need 
not be treated too actively. "When the process of teething 
goes on favorably, medical interference will be unnecessary. 
The child should be much in the open air, provided the 
weather is favorable ; sponging the head daily with cold 
water will be found beneficial ; caps and warm coverings to 
the head should be forbidden, as they only tend to favor the 
determination of blood to the brain and its membranes ; the 
gums should be frequently rubbed with the finger, to lessen 
the irritation ; the diet should be simple, and the bowels 
should be kept regular. 

"When the dentition is difficult, the treatment becomes 
more important. There are two indications to be followed : 
first, to relieve the local irritation ; and second, to subdue 
the constitutional disturbance. If, on examining the mouth, 
the gum is found hot, red, tender, swollen, and indurated, 
it is to be freely lanced ; taking care to divide the tissues 
down to the surface of the pressing tooth, even if this be at 
some little depth. When this operation is properly per- 
formed, immediate relief often follows ; but should the gen- 
eral disturbance persist, mild laxatives must be resorted to, 
and if there is much fever, the following mixture may be 
given : — 

Take of Spirit of Mindererus, . . .1 ounce, 
Syrup of Gum Arabic, . . .1 ounce. 

Mix. Give a teaspoonful three or four times a day. If 
the child is restless and irritable, five to ten drops of pare- 



CONVULSIONS. 211 

goric may be added to each dose. When there is much 
thirst, allow the child to drink freely of cold water. Where 
there are symptoms of determination of blood to the brain, 
employ warm baths, with cold applications to the head. 
Where symptoms of debility predominate, strengthening 
medicines do great good ; and in all cases take care to 
keep the bowels in a healthy condition, resorting to mild 
aperients, as castor-oil, or aromatic syrup of rhubarb, if 
constipation exist ; or to an astringent (R. 73), if the infant 
is being weakened by diarrhoea. 



DISORDERS OF THE SECOND DENTITION. 

The eruption of the permanent teeth does not usually 
give rise to any distress ; although instances occasionally 
occur where there is not only much local irritation, as 
evidenced by great pain in the gums and enlargement of the 
parotid and sub-maxillary glands, but also where serious 
general disturbance ensues, as shown by the occurrence of 
epilepsy, severe inflammation of the eyes, skin diseases, &c. 
Whenever the gum — whether indurated or not — seems to 
oppose the passage of the tooth ; or when the superimposed 
gum is tense, shining, and tender ; or when it is swollen 
and congested, and is attended with salivation and heat of 
mouth, then the lancet will give great, and almost imme- 
diate relief. 

CONVULSIONS. 

From the time of birth until the end of the fifth or sixth 
year, convulsions are of rather frequent occurrence, inas- 
much as they are produced by a variety of circumstances ; 
but they are most common during infancy, since this is not 
only the most excitable period of existence, but it is also 
exposed to its own peculiar sources of irritation. The at- 



212 MEDICAL AND SURGICAL COMPANION. 

tacks very commonly — when not symptomatic of severe 
cerebral disease — pass off without any bad results ; but 
when they recur frequently, they are very likely to weaken 
the intellect, and to impair the general health ; and in some 
instances they prove the immediate cause of death. 

A few days after birth the young child is apt to suffer 
from slight convulsive movements, to which nurses give the 
name of " inward fits." The baby lies as though asleep, 
rolls its eyes about, moans gently, breathes with a little dif- 
ficulty, and has twitchings of the muscles of the face ; 
sometimes there is a livid ring round the mouth. This con- 
dition arises from indigestion, and is readily relieved by 
gentle friction or rubbing over the abdomen, and the admin- 
istration of the following mixture : — 

Take of Aromatic Spirit of Ammonia, £ drachm. 
Compound Spirit of Ether, . £ drachm. 
Syrup of Gum Arabic, . . 15 drachms. 

Mix. Shake before using. Half a teaspoonful to a tea- 
spoonful, with the same quautity of water, may be given, 
and the dose repeated in an hour or two if necessary. 

Symptoms of Convulsions. In slight cases the symp- 
toms are nearly such as have just been described as inward 
fits ; but generally they are much more severe. Thus, when 
an attack comes on, the body becomes stiff and immovable ; 
the muscles of the face twitch, and the lips are drawn in all 
directions ; the integuments of the head and face become 
red and then livid ; the eyes start, the pupils are contracted 
or dilated, and insensible to light ; the breathing is irregular 
and laborious ; the pulse is very frequent and small ; the 
hands are generally firmly clinched, and the thumbs turned 
inwards ; and the contents of the bladder and rectum are 
voided involuntarily. At the end of one or more minutes 
the convulsions diminish for a few moments ; when they 
either recur or altogether cease. In the latter case, the 
limbs and features become relaxed, and the natural appear- 



CONVULSIONS. 213 

ance returns ; the child looks frightened and cries, and then 
either falls into a sound sleep, during which it becomes 
bathed with perspiration, or — in Unfavorable cases — sinks 
into a state of complete coma, and perhaps dies. 

Causes. Anything which over-excites the nervous system, 
or which interferes with the due performance of the functions 
of the nervous centres, is likely to induce a fit of convulsions. 
Hence the fits may arise from structural disease of the brain, 
as tubercle, inflammation, apoplexy, &c. ; from an insuffi- 
cient supply of blood to the brain, as in weak, badly-nour- 
ished children ; from a supply of impure blood, as is seen 
sometimes during the course of the eruptive fevers, or in 
the progress of kidney disease ; from distant irritation affect- 
ing the brain, such as arises from the pressure of a tooth 
upon the inflamed gum daring teething, or from intestinal 
worms, or even simple indigestion ; from general irritation 
produced by exposure to a cold and damp atmosphere ; and, 
lastly, they may be produced by fright, and by causes which 
we cannot discover. 

Treatment. This will, of course, vary according to the. 
circumstances of each case ; but the broad principles of 
treatment are as follows : During the fit, it will be advisa- 
ble to avoid all unnecessary interference ; it being generally 
sufficient to loosen the clothing about the neck, chest, and 
waist, to raise the head, to sprinkle the face with water, 
and to admit plenty of fresh air. Subsequently the warm 
bath may be of signal service, cold being at the same time 
applied to the head. When the bowels are confined, gentle 
purgatives will be needed ; when there is much wind in the 
bowels, carminatives (R. 51 or 52). When the stomach 
contains undigested food, an emetic (R. 2) ; when the irri- 
tation is due to teething, and the tense gum appears to 
offer an obstacle to the passage of the tooth, lancing the 
gum ; when there is restlessness, a sedative (R. 50) ; and 
when the blood is poor, tonics (R. 62 or 68). 



214 MEDICAL AND SURGICAL COMPANION. 



CHOLERA INFANTUM. INFANTILE DIARRHCEA. 

( The Summer Complaint of Infants.) 

The term cholera infantum, as commonly used in this 
country, embraces different pathological conditions, in fact, 
distinct affections, occurring in children under two years of 
age. These different conditions, however, may be devel- 
oped at different periods in the same case. In certain cases, 
the symptoms closely resemble those of the cholera morbus 
of adults. A child is seized with vomiting and purging, 
the latter usually occurring first ; the acts of vomiting and 
purging are violent and frequently repeated ; after the con- 
tents of the stomach and bowels are expelled, the evacua- 
tions consist of secreted transuded liquid in more or less 
abundance. The attack may cease or be arrested, and 
recovery speedily ensue, as in cases of the cholera morbus 
of adults ; but this favorable course does not obtain so 
generally in children as in adults. If the course be unfavor- 
able, the vomiting and purging continue in spite of efforts 
to check them ; the child is tormented with thirst, but every- 
thing is rejected from the stomach ; great prostration en- 
sues ; and death takes places in one, two, three, or four 
days. The fatal result may be preceded by convulsions 
and preternatural propensity to sleep. In some cases the 
violent symptoms cease, and the attack eventuates in a 
chronic affection, accompanied by diarrhoea and occasional 
vomiting. In other cases the affection is gastro-intestinal 
indigestion. These cases are characterized by diarrhoea, 
the evacuations at the commencement consisting of healthy 
feces, and then of loose, copious, bright-yellow stools. If 
the looseness continues, the motions assume a green, spinach- 
like appearance ; and frequently they contain numerous 
white specks, consisting of the casein of undigested milk. 
Vomiting occasionally occurs, but in some cases it may not 
appear at all. The diarrhoea is more or less persisting ; 



CHOLERA INFANTUM. 215 

the appetite is impaired or lost ; colic pains are apt to be- 
come troublesome ; the child progressively wastes, and death 
may take .place from inanition. In another class of cases 
the affection is inflammation of some portion of the intes- 
tinal canal. The discharges in these cases contain gelatinous 
or slimy mucus, which is occasionally tinged with blood. 
Some fever, with remissions, occurs in these cases. There 
is more or less abdominal tenderness and pain. Vomiting 
may be prominent, as a symptom, or occur only occasionally. 
Progressive emaciation and weakness mark the unfavorable 
progress of this affection. Head symptoms are often de- 
veloped in its course. The child becomes dull, and inclined 
to sleep ; lies with the eyelids partially closed, and fre- 
quently rolling the head from side to side. Convulsions 
and coma may occur before death. Under the head of 
cholera infantum, then, are commonly embraced cases of 
cholera morbus, diarrhoea from indigestion, inflammation of 
the intestines, and dysentery. The head symptoms, which 
are apt to be developed in unfavorable cases of each of these 
affections in the young child, were formerly attributed to 
inflammation of the membranes of the brain. They were 
supposed to denote a metastasis (change in the seat of the 
disease) to the head. It is not easy to say exactly what the 
morbid condition is, but it is not inflammation, and it is 
dependent upon the exhaustion produced by the abdominal 
disease. 

The affections embraced under the name cholera infantum, 
although not peculiar to America, doubtless prevail to a 
much greater extent in certain parts of this country than 
in Europe, owing, probably, in a great measure, to the heat 
in the summer months being greater here than abroad. 

Causes. The causation has relation to elevation of tem- 
perature — to excessive heat ; the affections prevail almost 
exclusively during the months of July, August, and Septem- 
ber. But something more than temperature is concerned 
in their production, for they are almost limited to cities and 



216 MEDICAL AND SURGICAL COMPANION. 

large towns, and are more prevalent in the Northern and 
Middle than in the Southern States. Children of the poorer 
classes, in insalubrious situations, living in crowded dwell- 
ings, are more liable to be affected ; but the children of 
those in easy circumstances, and of the wealthy, by no means 
escape. The irritation of teething, and the change of diet 
after weaning, doubtless render the system more liable to 
be affected. Infants brought up by hand are especially sub- 
ject to these affections. The diet of the child, after wean- 
ing, has much to do, if not with the causation of these 
affections, at least with the ability of the system to resist 
and overcome them. Restriction to insufficient articles of 
nourishment, such as arrowroot and gelatine, is one source 
of feebleness, and want of development and growth in in- 
infancy ; but there is reason to believe that infant mortality 
in cities is attributable, in no small measure, to the use of 
diluted, sophisticated, and artificial milk. The importance 
of undiluted milk, from a pure source, to the welfare of 
children, is far from being generally appreciated As the 
diet of infants must consist chiefly of milk, its purity is of 
the utmost importance. 

Treatment. The treatment, in the first place, will have 
reference to the form of cholera infantum which is pre- 
sented. In the acute form, resembling the cholera morbus 
of adults, in which there is a liability to a rapidly fatal 
termination by exhaustion from loss of fluids, the patient 
falling into a state of collapse, the indications are to arrest 
the vomiting and purging, to restore warmth to the surface 
by the application of dry, warm flannels, mustard-water, 
and the warm bath, and to sustain the powers of the system 
by wine or brandy, and proper nourishment. To arrest the 
vomiting, place a mustard poultice over the stomach, and 
give, according to the age of child, from five to fifteen 
grains of the subcarbonate of bismuth in a little syrup. 
Repeat the dose once in two or three hours, if necessary. 
At the same time, three to six drops of laudanum mixed 



CHOLERA. INFANTUM. 217 

with a tablespoonful or two of thin, warm starch may be 
injected into the bowels, and the injection may be repeated 
two or three times a day, if required. As children do not 
bear opium, or its preparations, well, begin with only three 
drops of laudanum, if the child be under one year, and watch 
its operation. Should the child be much prostrated by the 
disease, five to thirty drops of brandy may be given in a 
little water, every one, two, or three hours, according to the 
urgency of the case. 

Should not the subcarbonate of bismuth and laudanum 
arrest the vomiting and purging within a few hours, try the 
following powders as a substitute : — 

Take of Hydrargyrum cum Creta, . . 4 grains. 

Dover's Powder, . . .4 grains. 

Mix, and divide into six powders. One may be given in 
a little syrup, every second or third hour, to a child six 
months to one year old. "Warm baths generally prove ser- 
viceable. 

After the vomiting has ceased, if the diarrhoea still 
contiuues, the following mixture will usually prove ben- 
eficial : — 

Take of Fluid Extract of Spirea, . . £ ounce. 

Brandy, £ ounce. 

Syrup of Gum Arabic, . . 1 ounce. 

Mix. Give from half a teaspoonful to a teaspoonful, 
according to age of child, every two, three, or four hours. 
One or two drops of laudanum may be added to each dose 
in obstinate cases. 

Attention to diet and regimen is of prime importance. 
Many children undoubtedly die Avith these affections from 
au insufficiency of nutriment. Pure milk is the most ap- 
propriate article of food. It may be rendered more nutri- 
tious by the addition of boiled flour or powdered biscuit. 
Gelatine aud arrowroot, or other starchy substances, are in- 



218 MEDICAL AND SURGICAL COMPANION. 

adequately nutritious. The essence of meat and strong 
broths are often taken with avidity by very young chil- 
dren, and the desire for them should be indulged and en- 
couraged. 

Milk, to which a little lime-water has been added (one 
part lime-water to seven of milk), when given in small 
quantity at a time, will often be retained on the stomach, 
when other articles of nutriment are rejected. 

In that form of this disease arising from indigestion, 
pepsin (R. 64) often proves serviceable, after the discharges 
have been regulated. 

When we have inflammation of the intestines, and the 
discharges are slimy and streaked with blood, the laudanum 
and starch injections, before recommended, often prove very 
beneficial. Hot fomentations to the bowels also do great 
good. In all these cases, the child should be allowed to re- 
main as quiet as possible. The habit, in acute cases, of 
tossing the child about, rocking it on knee or in cradle, or 
of carrying it about much, proves injurious, by keeping the 
bowels in constant motion. 

The summer complaint of infants, from whatever cause 
arising, requires careful management. No two cases are 
precisely alike. In obstinate or chronic cases, removal from 
the city, either to a situation on the seaboard, or to some 
point inland, is the most efficient of all curative measures. 
The child should be in the open air as mnch as possible. 

In these cases, in conjunction with diet, alcoholic stimu- 
lants are highly useful. A few drops of brandy or whiskey 
may be given, at short intervals, with advantage. The 
elixir of pepsin, before mentioned, proves beneficial in nearly 
all chronic cases. 

The head symptoms, previously referred to, claim sus- 
taining measures — brandy and nourishment. Patients 
sometimes recover, after lingering for a long time on the 
verge of the grave. 

This being a very serious affection, always place the child 
under the care of a physician, when convenient. 



INFANTILE FEVER. 219 



INFANTILE FEVER. 

Simple or remittent fever in children occurs in two de- 
grees — in a mild and in a severe form. In the mild form 
the disease comes on gradually ; the child first loses its 
cheerfulness, its appetite fails, and it suffers from urgent 
thirst; during the day it is listless and fretful ; and though 
drowsy towards evening, yet its nights are restless, and it 
has no sound, refreshing sleep. On these symptoms attract- 
ing attention, the skin is found hot, and at some hours 
of the day dry ; at others covered with perspiration ; the 
bowels are generally loose, the evacuations being unhealthy 
and offensive ; sometimes there is obstinate constipation. 
In the second week the symptoms increase ; the child passes 
very bad nights, screams and starts in its sleep, suffers much 
from thirst, and occasionally has slight delirium ; there is 
increase of the fever towards evening, which diminishes as 
the morning approaches ; occasionally there is a second, 
though less severe, increase about eleven o'clock in the 
forenoon. In mild cases there is seldom any rash ; if auy 
appear, it will be at this time. The skin of the lips, face, 
and fingers becomes dry and rough, and the child is con- 
stantly picking it. Towards the end of the second or the 
beginning of the third week the symptoms usually begin to 
abate, and day by day the child improves in health, although 
some time often elapses before convalescence is completely 
established. In severe cases, the symptoms just enumerated 
commence more suddenly, and are more strongly marked ; 
there is frequent and scanty eruption, which appears between 
the sixth and tenth days. As the disease progresses, the 
restlessness and delirium become gradually aggravated ; the 
evacuations are passed unconsciously, and the child becomes 
much emaciated ; until, when apparently in the worst possi- 
ble condition, slight signs of amendment show themselves, 
followed by daily improvement. The cases which terminate 
fatally are few in number. 



220 MEDICAL AND SURGICAL COMPANION. 

Treatment. This fever has a natural course to run ; 
and our object must be, as in the treatment of fever in 
the adult, to enable our patient to bear up against the dis- 
ease. At first, medicine is little needed ; but when the skin 
is hot and dry, and pulse rapid, the following mixture may 
be given with benefit : — 

Take of Liquid Acetate of Ammonia, . 1 ounce. 

Sweet Spirit of Nitre, . . 2 drachms. 

Syrup of Gum Arabic, . . 6 drachms. 

Mix. From half a teaspoonful to a teaspoonful, accord- 
ing to the age of the child, may be given in a little cool 
water every third or fourth hour. Plain water or toast- 
water may be allowed rather freely as a drink. Sponging 
the whole body with warm water (containing a little salcra- 
tus) every morning will prove beneficial. The unhealthy 
diarrhoea will be best relieved by giving a dose of castor-oil, 
and after its operation, the following powders : — 

Take of Hydrargyrum cum Creta, . . 4 grains. 

Dover's Powder, . . .2 grains. 

Mix, and divide into three powders. One may be given 
in a little molasses or syrup every third hour, until all are 
taken. 

When the child is very weak, good beef tea, chicken 
broth, and a little wine or brandy will be required. Dur- 
ing convalescence, milk, beef tea, &c, will be necessary. 
Change of air, if in an unhealthy locality, will prove of 
great advantage. 

To procure sleep during this fever, five to fifteen drops 
of paregoric, or one half to two grains of Dover's powder, 
according to the age of the child, may be given at bedtime, 
when necessary. 



INCONTINENCE OF URINE. 221 



INCONTINENCE OF URINE. 

Incontinence of urine may occur in early life from many 
causes. ' It may be associated with a tendency to kidney 
disease, or with a disposition to gravel, or it may depend 
upon constitutional weakness and irritability, or it may be 
due to an increase of uric acid in the urine. 

The troublesome involuntary flow of urine during sleep, 
which is so common in young children, may result from 
any of the causes of incontinence ; hence in all cases of the 
kind, the urine should be examined by a competent physi- 
cian, who should always be consulted in regai'd to these 
cases when obstinate. 

Treatment. By seeing that the little patient passes 
water immediately before going to bed ; by waking him to 
empty his bladder two or three times during the night, the 
wetting of the bed may, in some cases, be prevented. 

Tone and strength may be given to the system by the 
administration of the following preparation of iron : — 

Take of Tincture of Chloride of Iron, . 1 drachm. 
Pure Water, . ... 4 ounces. 

Mix. A child three to four years old may take from half 
a teaspoonful to a teaspoonful, in a little water, three times 
a day. A child six to eight years of age may take from 
one to two teaspoonfuls. Where the bladder is very irrita- 
ble, a belladonna plaster over the lower part of the back 
will often do much good ; or three to five grains Of the 
extract of this drug may be rubbed into the same region 
every night. 



222 MEDICAL AND SURGICAL COMPANION. 



CHAPTER XIV. 

ON SUSPENDED ANIMATION, POISON- 
ING.. &c. 

SUSPENDED ANIMATION FROM DROWNING. 

The patient should be treated instantly on the spot, in the 
open air, the face, neck, and chest being freely exposed to 
the breeze, except in severe weather. 

In order to clear the throat, place the patient gently on the 
face, with one wrist under the forehead, that all fluid, and 
the tongue itself, may fall forward, and leave the entrance 
into the windpipe free. 

To excite respiration or breathing, turn the patient slightly 
on his side, and apply some stimulating agent to the nostrils, 
as ammonia or hartshorn ; also rub the face a little to 
make it warm ; then dash a little cold water upon it. If 
these efforts do not prove successful, lose no time, but pro- 
ceed to initiate respiration or breathing, by placing the patient 
on his face, and then turning the body gently but com- 
pletely on the side, and a litttle beyond; theu again on 
the face, and so on alternately. Repeat these movements 
deliberately and perse veringly, fifteen times only in a 
minute. 

When the patient is rolled so that his face is downward, 
the chest (thorax) is compressed by the weight of the body, 
and air is forced out. When he is rolled back on the side, 
this pressure is removed, and a fresh portion of air rushes 
in. As often as the patient is rolled on to his chest (face 
downwards), make a uniform and efficient pressure along the 



FROM DROWNING. 223 

lack, removing the pressure immediately, before turning on 
the side. The pressure along the back aids in expelling air 
from the chest ; as soon as the pressure is removed, and the 
patient rolled upon the side, a fresh supply rushes in to fill 
its place, and in this way natural breathing is imitated. The 
patient's limbs may at the same time be rubbed upward with 
firm pressure, and with energy ; the object of the rubbing 
being to obtain the return of venous blood to the heart. 

Substitute for the patient's wet clothing such other gar- 
ments and covering as can be instantly procured, each by- 
stander, if necessary, furnishing a coat, cloak, or some other 
article. 

Slapping the body occasionally and briskly with the hand 
tends to excite inspiration. The body should be rubbed 
smartly until dry and warm ; then cold water dashed upon 
it, and the rubbing be repeated. 

Avoid, if possible, the immediate removal of the patient, 
as it involves a dangerous loss of time. 

The old methods of rolling the body of a drowned person 
on a barrel, holding it up by the heels, blowing into the 
windpipe with bellows, and all rough treatment, should be 
avoided, as full of danger. 

Injecting into the bowels warm brandy and water, and 
rubbing the surface of the body with warm spirit, may prove 
beneficial. Should the accident occur in winter, and the 
body feel cold, as if frozen, before applying warmth, rub it 
well with snow, or very cold water. Above all things, re- 
member that perseverance for many hours in the use of the 
remedies pointed out may give you the unspeakable pleasure 
of restoring a fellow-being to life. 

When the patient begins to revive, a little warm spirit and 
water may be given from time to time, and he should be 
allowed to remain at rest until he feels inclined to rise. 

When a person has been taken from the water, and efforts 
are being made to resuscitate him, a crowd of persons will 
soon collect, if near a town, and, by their presence in the 



224 MEDICAL AND SURGICAL COMPANION. 

room, or around the patient, if in the open air, do much 
harm by rendering the air impure, and interfering, perhaps, 
with the operations of those who have charge of the pa- 
tient ; therefore, never allow any more to be about the patient 
than can in some way be made useful. 

FROM HANGING. 

When a person is found suspended by the neck, he should 
be immediately taken doivn, and the cord, or other article 
constricting the neck, loosened, and removed at once. Then 
attempt to resuscitate in the same manner as directed in 
cases of drowning. 

FROM GAS, FOUL OR IMPURE AIR. 

Throw open the doors and windows, or take the patient 
into another room, or the open air, which is preferable ; then 
treat as directed in cases of drowning. 

FROM COLD. 

Place the body in a cool room, away from fire, and rub it 
well and briskly with snow, or, if this cannot be obtained, 
cold water. After a while frictions, with flannels and warm 
spirit, may be used ; but warmth should be very gradually 
applied. 

Natural breathing may be initiated as directed in cases 
of drowning, and when the patient begins to revive, warm 
spirit may be given in small quantities. 

If a limb is frostbitten, the cold applications should be 
continued longer, and warmth be more gradually applied than 
when the whole body is frozen. 

Care should be taken to handle the parts carefully, so as 
not to break off an ear, or tip of the nose. 

BOAT ACCIDENTS. 

If upset in a boat, or in any other way precipitated into 
the water, without being able to swim, draw in the breath, 



SEA-SICKNESS. 225 

keep your mouth as well shut as possible, and do not throw 
your arms about ; endeavor to hold your head up, yield 
yourself to the buoyant powers of the water, and stretch 
out your hands, but only below, not above, the surface. 
Remember, that the less you expose above the surface, the 
better are you buoyed up. Many persons are drowned 
merely from struggling and throwing up their hands. 



CLOTHES CATCHING FIRE. 

The moment that you see your clothes on fire, remain 
calm and collected ; do not, on any account, run away in 
fright. If there be a rug, table cover, sheet, quilt, or any- 
thing of the kind at hand, roll it tightly about you to 
smother or extinguish the flames. The free application of 
water should be made as soon as possible. 



SEA-SICKNESS. 

This affection consists of nausea and vomiting, occurring 
to persons upon their going to sea. It is a troublesome 
and distressing affection, and varies in respect to severity 
and duration in different individuals. 

Treatment. Perfect rest in the recumbent position, ex- 
posure of the body to the cool, fresh air on deck, instead of 
going into the cabin or between the decks. 

Twenty-five or thirty drops of laudanum in a small glass 
of sherry wine or brandy will often relieve the sickness. 
If immediately vomited, repeat the dose. 

From half a drachm to a drachm of sulphuric ether, with 
a little spirit and water, often proves serviceable. In some 
cases the compound spirit of ether (Hoffman's Anodyne), in 
half drachm to drachm doses, gives great relief. 

Chloroform, in doses of thirty to sixty drops, taken in a 
little gum arabic water, is said to be excellent. 
15 



226 MEDICAL AND SURGICAL COMPANION. 

POISONING. 

Cases op Poisoning, accidental and otherwise, are so 
common, and so sudden and terrible, that it is important for 
every person to have some knowledge of what should be 
done in such instances. 

Our chief reliance in these cases is upon free vomiting, 
induced by those articles which are most speedy in their 
effect. 

FROM OPIUM, LAUDANUM, OR MORPHINE. 

Stir up, in a cupful of warm water, one or two teaspoonfuls 
of pure ground mustard, and see that the patient takes it 
immediately. Repeat the dose if necessary, and when the 
patient begins to vomit, give freely of warm water until the 
stomach is thoroughly cleared out. Sulphate of zinc, in 
doses of twenty grains to a drachm, may be used instead 
of the mustard, and in the same way, if it be at hand ; but 
it is important that no time be lost. Tickling the throat with 
a feather will tend to excite vomiting. 

After the stomach has been thoroughly evacuated, give a 
cupful of pure strong coffee. The patient should not be al- 
loioed to sleep for at least twelve hours, and if so much of the 
poison has been absorbed that the patient is with difficulty 
kept awake, he must be walked about, the room by assist- 
ants ; or if the weather be warm, he may be taken into the 
open air. If obliged to remain in a room, the windows 
should be opened to admit the fresh air. Cold water may 
occasionally be dashed on the head and shoulders. If, when 
first discovered, the patient is in such a condition that emet- 
ics will not operate, a stomach-pump should be used, if one 
is at hand, and there is any party present who understands 
using it. In some cases a galvanic battery, properly used, 
may be of much service. 

In all cases of poisoning, summon a physician as soon as 
possible, if one be obtainable. 



227 



FROM ARSENIC. 



la the treatment of poisoning by arsenic, it is best first (if 
vomiting has not taken place) to give an emetic of mustard 
or sulphate of zinc ; and milk may be drunk liberally, both 
before and after vomiting has begun. The patient should 
never be allowed to exhaust his strength in retching without 
some milk, or other fluid, in his stomach for that organ to 
act on. 

The Hydrated Peroxide of Iron, freshly prepared, is 
an antidote for poisoning by arsenic. It should be admin- 
istered as soon as possible after the discovery that arsenic 
has been taken. It is perfectly harmless, and should be 
given in tablespoonful doses, every five or ten minutes, until 
entire relief is obtained, or until ten to twenty doses have 
been taken. The dose for children is one or two teaspoon- 
fuls. The bottle should be well shaken before each dose. 
Should the patient survive (and the probability is in his 
favor, if the antidote be given early and faithfully), the in- 
flammatory symptoms must be combated on the general 
principles for treating inflammation. The diet should con- 
sist exclusively of milk, gruel, cream, rice, and similar 
bland articles for several days. 

In place of the hydrated oxide, the rust of iron and the 
precipitated carbonate should be resorted to in cases of emer- 
gency, possessing as they do, to a certain extent, the power 
of autidotes. 

ALCOHOLIC LIQUORS. 

Large quantities of alcoholic liquors sometimes produce 
fatal effects. The treatment in such cases is to evacuate 
the stomach as soon as possible ; but, from the rapidity of 
absorption, this may not always be effectual. The patient 
should be kept roused, and cold effusion to the head plenti- 
fully used. 

ALKALIES. 

Ammonia, potassa, and soda are seldom taken in poisonous 
quantities ; but when it so happens, the best antidote is 



228 MEDICAL AND SURGICAL COMPANION'. 

common vinegar. When this is not at hand, some oil, such 
as olive oil, lard oil, or goose oil, may be freely taken. 

MINERAL ACIDS. 

Give freely ivater, warm or cold, milk, oil, or mucilage, 
which, by simply diluting the acids, renders them less acrid, 
and at the same time assists the stomach in rejecting them. 
This course should be followed until the proper antidotes 
are prepared. These are the alkalies, potassa, soda, mag- 
nesia, aod soap in solution. 

OXALIC ACID. 

Death from this poison is generally sudden. Lime water, 
or a mixture of chalk and water, has been recommended for 
the purpose of converting the acid into oxalate of lime. 

Warm water should not be given to accelerate vomiting, 
for dilution promotes the absorption of the poison. 

PRUSSIC ACID AND STRYCHNIA. 

These poisons act with such rapidity as to leave no time 
for the administration of antidotes. 

CORROSIVE SUBLIMATE. 

This is an active poison, and being an ingredient of most 
" Bed-bug Poisons" is liable to be taken by mistake. 

Our chief reliance is in the albumen or whites of eggs, 
which should be copiously swallowed, or introduced through 
the stomach-tube, which should be resorted to when the 
patient cannot swallow or vomit. Wheat flour, mixed with 
water, and taken in abundance, may be used when eggs 
cannot be obtained. When neither eggs nor wheat flour 
are at hand, milk forms a good substitute. 



The sugar of lead (acetate of lead) is the only preparation 
which is resorted to as a poison. 



TRICHINA SPIRALIS. 229 

Epsom salts (sulphate of magnesia) is a true antidote, as 
it converts the poison into a sulphate of lead, which is in- 
ert. The bicarbonates of soda and potassa are also good an- 
tidotes, and when sulphate of magnesia cannot be obtained, 
either may be used, dissolved in water. Care should be 
taken not to give too large a quantity. If the patient does 
not vomit, powdered mustard, or sulphate of zinc dissolved 
in water, may be given, as directed in poisoning by opium. 



TRICHINA SPIRALIS. 

The trichina spiralis is a parasite found especially in the 
muscles of hogs. But it has been found in the muscles of 
various other animals, viz., eels, cats, dogs, badgers, hedge- 
hogs, and moles. The animal finds its way into the alimen- 
tary canal of man chiefly from eating trichinous pork not 
subjected to processes of cooking sufficient to destroy the 
parasites. They are not destroyed by smoking, and they 
may retain their vitality in roasted or broiled meat much 
underdone. This parasite, as found in the muscles, is coiled 
up in a cyst, containing a granular substance at first, and 
afterwards calcareous matter. When expelled from the 
cyst, the parasites are seen to be round worms, ^ of an inch 
long, and ^^ of an inch in thickness. So long as they re- 
main in the muscular tissue, the worms are quiescent and 
sexless. When, however, they are taken into the stomach, 
and set free by the action of the gastric liquids upon the 
muscular tissue and the cysts, they pass from the stomach 
into the intestinal canal, and immediately begin to grow 
rapidly, attaining to three or four times their former size, 
acquire fully developed generative organs, and in the course 
of a week to ten days the female parasites contain living 
young iu great abundance. The young trichina? shortly after 
birth penetrate the mucous membrane, and find their way 
rapidly to the different muscles throughout the body. In a 



230 MEDICAL AND SURGICAL COMPANION. 

piece of muscle yL- of an inch square, and -^ of an iuch thick, 
twelve trichinae have been counted, which would give, in 
round numbers, over eighty-five thousand to the cubic inch. 
The trichina? which have been found to be contained in half 
a pound of meat may be sufficient to give birth, in a few 
days, to a brood numbering thirty millions. The introduc- 
tion of these minute worms into the system gives rise to a 
disease of great gravity, involving much danger to life. 
This disease is at the present time exciting great interest, 
not only in this, but other countries. It is known as 

THE TRICHINAL OR TRICHINAT0US DISEASE, OR TRICIII- 
NIASIS. 

Symptoms. Abdominal pains and diarrhoea characterize 
the first stage of the disease. These symptoms occur within 
a few days after eating the diseased meat ; that is, as soon as 
the young worms have been produced and become developed 
sufficiently to begin to migrate towards the muscles. The 
secondary symptoms relate to the muscles. Pains, resem- 
bling those of muscular rheumatism, are occasioned by the 
entrance of the trichina? into the muscles. Certain of the 
muscles become contracted in some cases, and their exten- 
sion occasions great suffering. Constitutional disturbance, 
more or less marked, accompauies both the primary and 
secondary symptoms. The general symptoms are not unlike 
those of typhoid fever, for which the disease is liable to be 
mistaken. (Edema of the face or lower extremities is apt 
to occur, and sometimes anasarca — dropsy of the flesh. 
Sweating is generally prominent as a symptom. Death 
takes place, in a certain proportion of cases, after a pro- 
tracted period of suffering and exhaustion, being often pre- 
ceded by a preternatural propensity to sleep. The danger, 
other things being equal, is proportionate to the abundance 
of trichina? generated within the alimentary canal. If the 
number be not sufficient to cause death from the amount of 
local and constitutional disturbance which they occasion, 



TRICHINA SPIRALIS. 231 

recovery takes place very slowly, the illness lasting for sev- 
eral weeks or even months. The trichinae become encapsu- 
lated in the muscles, thereafter remaining quiescent, leaving 
the muscles more or less impaired. 

Diarrhoea and abdominal pains, followed by muscular 
pains, together with more or less constitutional disturbance, 
should excite suspicion of this disease, and lead to a micro- 
scopic examination of the suspected meat, if any remains. 
It may als.o be well to have a portion of the feces examined 
microscopically. To early distinguish the affection is of 
the greatest importance, as the treatment of this disease, to 
be effectual, must be employed while the worms are in the 
alimentary canal. 

Treatment. The object is either the destruction of the 
worms or their expulsion from the intestines. Cathartics 
are indicated for the latter object, but we have yet to learn 
what worm poisons are best suited to destroy this parasite. 
After the trichinae have left the intestines, the opportunity 
for destroying or expelling them has passed. Recovery now 
depends on the ability of the system to endure them until 
they become encysted. Measures to relieve urgent symp- 
toms, and to support the powers of life, are indicated, and 
the success of the treatment will depend on the judicious 
employment of measures for these ends. 

To prevent this disease, abstain from meat, more especial- 
ly the flesh of swine, not thoroughly cooked. 



Animals, such as snakes, slugs, and lizards, are not infre- 
quently exhibited to physicians, as having passed from the 
alimentary canal. It is a popular notion that they may live 
and grow indefinitely within the stomach and intestines, and 
give rise to a variety of morbid symptoms. It is safe to 
set down all the cases referred to, as cases of either self- 
deception or imposition. 



232 MEDICAL AND SURGICAL COMPANION. 



DISEASED AND DECAYING FOOD. 

Diseased and decaying food, whether animal or vegetable, 
should be scrupulously avoided, as being very unwholesome, 
and liable to cause sickness. Meats, vegetables, fruit, 
and berries often remain in market so long before sold that 
they are unfit for nourishment. Pork and beef, from ani- 
mals fatteued on unwholesome food, and which are conse- 
quently in a diseased condition, are often brought into mar- 
ket. These facts should be borne in mind, and great care 
observed in selecting articles of diet. 



CAUTION TO PERSONS OVERTAKEN BY A 
THUNDER-STORM. 

Never take shelter under a tree, haystack, wall, or fence, 
— such objects attracting the lightning, and endangering 
any one near them. It will be best to keep in the middle 
of the field or road, especially if raining, the lightniug often 
passing harmlessly over a body whose surface is wet. Above 
all, do not hold up an umbrella, more particularly one with 
iron frames, the use of which, at such times, is highly dan- 
gerous. 

When a person has been struck down by lightning, efforts to 
resuscitate may be made in the same manner as directed for 
cases of drowning. Electricity or galvanism may be used to 
advantage. 



PAET II. 
PRACTICE OP SURGERY. 



CHAPTER I. 



ACCIDENTS, WOUNDS, SURGICAL INJU- 
RIES, &c. 

PROSTRATION. COLLAPSE. SHOCK. 

By prostration, or collapse, or shock to the nervous system, is 
meant that general depression of the powers and actions of 
life which immedietely follows any severe injury. 

Symptoms. Coldness ; insensibility, more or less perfect ; 
pulse weak and fluttering ; respiration sighing ; sometimes 
nausea, or vomiting, or convulsions. 

Causes. Every variety of injury to which mind or body 
is liable ; as mechanical injuries, falls, blows, great and 
sudden extremes of grief, or joy, or fear, or cold ; large 
doses of any corrosive or sedative poisons ; great loss of 
blood, &c. 

Treatment. If a patient has just received a severe inju- 
ry, and that, independently of bleeding, or of any local inju- 
ry, he is in such a state of faintness and depression as to 
render his life precarious, the indication is to excite the 
heart aud brain to a moderate and healthy reaction ; and 
this may be done by giving a little hot brandy, or other 
spirit, and water. Heated bricks, or bottles of hot water, 
may be applied to the feet, and at the sides of the chest, and 

(283) 



234 MEDICAL AND SURGICAL COMPANION. 

the patient covered with warm blankets, &c, if in cold 
weather. 

When warmth and circulation have been restored, cease 
to give spirit, so that you may not run the risk of setting up 
fever, or bringing on bleeding from any internal organ that 
may have been injured. If vomiting takes place, a little 
soda water with brandy may allay it. Sucking ice Avill 
sometimes answer. If these fail, an adult may take one or 
two grains of opium, in pill. 

Formerly it was the custom to bleed patients immediately 
after an injury, and before they had recovered from a state 
of faintness, but such would now be regarded bad practice. 

"When a person has received a severe injury, some regular 
physician should be called, if within reach. 



METHODS OF ARRESTING HEMORRHAGE OR 
BLEEDING. 

The occurrence of bleeding from cuts, wounds, &c, if 
considerable, always demands immediate attention. 

"When an artery is wounded, the blood spirts, or is thrown 
out in jets, and is of a florid color. The blood from ;i veto 
flows or wells out in a continuous stream, as water ri.-cs 
from a spring, and not in jets, and is of a darker color than 
arterial blood. Bleeding from superficial wounds, or abra- 
sions, when no vessel of notable size is opened, may gener- 
ally be checked by sponging the part with iced water, or, if 
in winter, by applying a little snow to the wound. A 
strong solution of alum is good. Tannin and powdered 
matico leaves are also excellent. 

If an artery of considerable size has been cut, and the 
blood flows in spirts, or with a jerk, place your finger on 
the spot it springs from, and hold it there with a firm pres- 
sure, while you direct some one to pass a handkerchief, or 
other article, round the limb (supposing the cut or injury to 



HEMORRHAGE OR BLEEDING. 235 

be in one) above the wound, and to tie its two ends together 
in a hard knot. A whip-handle, cane, or stick must now be 
passed under the knot (between the upper surface of the 
limb and handkerchief), and turned round and round, until 
the handkerchief encircles the limb with considerable tight- 
ness. Then take off your finger ; if the blood still flows, 
tighten the handkerchief, by a turn or two of the stick, until 
it ceases. The patient may now be removed (taking care 
to secure the stick in its position) without running any risk 
of his bleeding to death by the way. 

As this apparatus cannot be kept on long without destroy- 
ing the life of the parts, endeavor, as soon as possible, to 
secure the bleeding vessel, and take it off. If you have no 
ligature silk, wax together three or four threads of sufficient 
length, cut the ligature they form into as many pieces as 
you think there are vessels to be taken up, each piece being 
about a foot long. With a sponge or cloth, moistened with 
water, wash the blood from the part ; then, with a sharp 
hook (tenaculum) or slender pair of forceps in your hand, 
fix your eye steadfastly upon the wound, and direct the 
handkerchief to be relaxed by a turn or two of the stick ; 
you will now see the mouth of the artery from which the 
blood springs ; seize it with your hook or forceps, draw it a 
little out, while an assistant passes a ligature round it, and 
ties it tightly with a double knot. In this way take up 
every bleeding vessel you can see or get hold of. 

If the wound is too high up in a limb to apply the hand- 
kerchief, do not lose your presence of mind ; the bleeding 
can still be controlled. If it is the thigh, press firmly in 
the groin ; if in the arm, with the hand end or ring of a 
common door-key, make pressure above the collar bone, and 
about its middle, against the first rib which lies under it. 
The pressure is to be continued until assistance is procured 
and the vessel tied. 

If the wound is on the head, press your finger firmly on it, 
uutil a compress can be brought, which must be bound firmly 



236 MEDICAL AND SURGICAL COMPANION. 

over the artery by a bandage. If the wound is in the face, 
or so situated that pressure cannot be effectually made, or you 
cannot get hold of the vessel, and the blood flows fast, place 
a piece of ice directly over the wound, and let it remain 
there till the hlood coagulates, when it may be removed, and 
a compress and bandage applied. 

A little cotton wool, moistened and rolled in tannin, or 
powdered matico leaves, if bound firmly upon the part, will 
often arrest the hemorrhage. 



INFLAMMATION. 

By inflammation, is understood that condition of a part 
characterized by pain, heat, redness, and sxoelling. 

The pain is caused by the increased quantity of blood in 
the part pressing on the nerves. 

The REDNESS, by the increased quantity of blood in the 
part, and by stagnation of the current ; vessels, naturally too 
small, admitting the red corpuscles. 

The heat, by the increased quantity of blood, and the 
more rapid oxidation of the tissues, &c. 

The swelling, by increase in the quantity of blood, and 
by effusion into the tissues of lymph, serum, pus, &c. 

TERMINATIONS OF INFLAMMATION. 

Inflammation may terminate in recovery ; sudden change 
from one part to another ; effusion of fluid, as in dropsy 
of the chest ; in adhesion ; in ulceration ; in mortification 
or gangrene. Inflammation may be either acute or chronic. 
When wounds are undergoing the process of repair, there 
arises a certain amount of inflammation which is termed 
healthy, so long as it remains within proper bounds. But 
when it exceeds these bounds, and when it arises from other 
causes than wounds and injuries, treatment is required. 

In inflammation the pain is constant, and increased on 
pressure. 



INCISED WOUNDS. 237 

Treatment. If possible, rest the part and elevate it. A 
thorough purgative may be taken, and the diet should be 
low. Apply warm or cold water to the part, according to 
the feelings of the patient. Leeches or cupping may be 
required. Low forms of inflammation, occurring in persons 
very much debilitated, require tonics and stimulants. 

MORTIFICATION. 

By mortification, is understood the death of any part of 
the body in consequence of disease or injury. 

Gangrene is a term applied to parts nearly, but not quite, 
dead. 

Symptoms. When inflammation is about to terminate in 
mortification, the part becomes of a purple or blue color, 
and the heat, sensibility, and pain diminish ; but the 
swelling may increase, and little blisters often form on the 
part. 

Treatment. Support the strength by milk, essence of 
beef, &c, and give wine or brandy with quinine (R. 146). 
Poultices containing charcoal, or a little diluted liquid chlo- 
ride of soda, may be. applied to the part. 



WOUNDS AND THEIR TREATMENT. 

INCISED WOUNDS. 

By an incised wound, is meant a clean, smooth cut. 

Treatment. Having stopped the bleeding, wash away 
all blood, and any foreign matter which may be in the 
wound ; then draw the edges together, and hold them in 
that position by narrow strips of adhesive plaster, placed 
a little distance apart. A soft compress of old linen or lint 
may be laid over the whole, and secured, if necessary, by a 
bandage. Small cuts, which bleed but little, only require 
narrow strips of adhesive plaster to keep their edges to- 
gether. 



238 MEDICAL AND SURGICAL COMPANION. 

Should much inflammation follow an incised wound, re- 
move the strips of adhesive plaster, and keep the patient quiet 
and on a low diet. If it is plain that matter (pus) must form 
before the wound will heal, apply a flaxseed or slippery-elm 
poultice until that event takes place, after which dress, uight 
and morning, with simple ointment, carefully cleausing the 
wound with warm water or soap suds at each dressing. 

Although narrow strips of adhesive plaster form the best 
means of keeping the sides of the wound together, when 
they can be applied, yet in the ear, nose, tongue, lips, and 
eyelids, it is necessary to use stitches, which are made in 
the following manner : Having armed a suture needle, of 
proper size, with a piece of waxed ligature silk, pass the 
point through the skin, at a little distance from the edge of 
the cut, and bring it out of the opposite one at the same 
distance. If more than one stitch is required, repeat the 
operation until a sufficient number are taken, leaving the 
threads loose, until all the stitches are passed, when the 
respective ends of each thread must be tied in a hard double 
kuot, drawn in such a way that it bears a little on the sides 
of the cut. When the edges of the wound are partly united, 
as they will usually be in two to four days, cut the knots 
and carefully withdraw the threads. 

From what has been said, it must be evident that in all 
wounds, after arresting the flow of blood and cleansing the 
parts, the great indication is to bring their sides into con- 
tact, throughout their whole depth, in order that they may 
grow together as quickly as possible, and without the inter- 
vention of matter. To obtain this very desirable result, in 
addition to the means already mentioned, there are two 
things to be attended to — the position of the patient and 
the application of a bandage. The position of the patient 
should be such as will relax the skin and muscles of the part 
wounded, thereby diminishing their tendency to separate. 
A common bandage, of a proper width, passed over the com- 
presses moderately tight, not only serves to keep them in 



PUNCTURED WOUNDS. 239 

their proper place, but also tends, by its pressure, to for- 
ward the great object already mentioned. If, however, the 
wound is so extensive and painful that the limb or body of 
the patient cannot be raised for the pnrpose of applying or 
removing it, the best way is to spread the two ends of one 
or two strips of linen or leather with adhesive plaster (com- 
mon machine-spread adhesive plaster will answer), which 
may be applied in place of the bandage, as follows : Attach 
one end of a strip to the sound skin, at a short distance from 
the edge of the compress, over which it is to be drawn with 
moderate firmness, and secured in a similar manner on its 
opposite side. A second or third may, if necessary, be added 
in the same way. 

In all wounds, if violent inflammation comes on, reduce it 
by purging, low diet, leeching, &c. If there is great pain, 
some opiate may be given, as occasion requires ; and if 
suppuration seems to be taking place, the dressing may be 
removed, and poultices of flaxseed meal, or ground slippery- 
elm bark, applied from time to time. 

PUNCTURED WOUNDS. 

These are caused by pointed instruments, as nails, needles, 
awls, swords, bayonets, splinters of wood, &c. If there is 
much bleeding, that should be stopped ; and any foreign 
body which may be in the part, withdrawn ; and, providing 
it becomes necessary, the wound may be enlarged a little, to 
enable you to do it. When pus or matter forms, it should 
be allowed free exit, and the part covered with mild dress- 
ings, as a common sore. Should inflammation become 
excessive, leeches, low diet, and purgatives may be re- 
quired. To relieve pain, laudanum or Dover's powder may 
be occasionally taken, according, to directions given for 
usin" these medicines. 



240 MEDICAL AND SURGICAL COMPANION. 



CONTUSED AND LACERATED WOUNDS. 

These resemble each other, and are caused by round or 
blunt bodies, as musket-balls, clubs, stones, machinery, &c. 
They are, in general, attended by but little bleeding ; if, 
however, there should be considerable, it must be arrested, 
and all foreign bodies carefully removed from the injured 
part. If the parts injured are much torn, wash them with 
warm water, and then (having secured all bleeding vessels) 
lay them down in as natural a position as possible, drawing 
their edges gently together by strips of adhesive plaster, or 
stitches if necessary. Apply soft anodyne dressing, made by 
wetting lint, or soft cloth, with the following lotion : — 

Tincture of Opium, .... 1 ounce, 

Tincture of Arnica, .... 1 ounce, 

Water, ...... 4 ounces. 

Mix. 
When suppuration, or the formation of pus takes place, 
flaxseed or slippery-elm poultices may be used. Pain may 
be relieved by appropriate doses of laudanum or morphine. 



WOUNDS OF PARTICULAR PARTS. 

WOUNDS OF THE SCALP. 

In all wounds of the scalp, the hair should be shaved off 
around the injury. When this is done, wash the parts, and 
draw the edges of the wound together with adhesive plaster. 
If it has been violently torn up in several pieces, wash and 
lay them all down on the skull again, drawing their edges 
as nearly together as possible with strips of adhesive plas- 
ter, or, if necessary, by stitches. Cover the whole with a 
soft compress, smeared with a little simple ointment, or wet 
with the lotion recommended for contused and lacerated 
wounds. If much inflammation arises, and suppuration 
ensues, poultices may be required. 



WOUNDS OF THE CHEST. 241 



WOUNDS OF THE EAR AND NOSE. 

Wash the parts clean, and draw the edges of the wound 
together by as many stitches as are necessary. If the part 
is even entirely separated, and has been trodden under foot, 
by washing it in warm water, and placing it accurately in 
its proper place by the same means (stitches), it may still 
adhere. 

WOUNDS OF THE THROAT. 

When the throat is wounded, seize and tie up every bleed- 
ing vessel which you can get hold of. If the trachea or 
windpipe is cut wholly or partially through, bring its edges 
together by stitches, taking care to pass the needle through 
the loose membrane which covers the windpipe and not 
through the windpipe itself. The head should be bent on 
the breast, and secured in that position by bolsters and 
bandages, to favor the approximation of the edges of the 
wound. 

WOUNDS OF THE CHEST. 

If it is a simple incised wound, draw the edges together 
with adhesive plaster, cover it with a compress of linen, 
and pass a bandage round the chest. The patient should 
be kept quiet, and on a low diet, to prevent inflammation. 

Should the wound be occasioned by a bullet, extract it 
if possible, together with any pieces of cloth or other for- 
eign body which may be in it ; then cover the part with 
a piece of linen, smeared with a little simple ointment ; 
taking care, at each daily dressing, that any matter which 
may have collected has free exit. If the wound extends 
into the cavity of the chest, and a portion of lung protrudes, 
return it as quickly and gently as possible. In such cases 
the services of a reliable medical man are required, and 
should be obtained if possible, as under the very best treat- 
ment the case may result unfavorably. 
16 



242 MEDICAL AND SURGICAL COMPANION. 



WOUNDS OP THE ABDOMEN. 

If a simple incised wound, and the bowels are not injured, 
close the wound by adhesive plaster, or. if necessary, by 
stitches passed through the skin, about half an inch from its 
edges, and cover the whole by a soft compress, secured by a 
bandage. Any inflammation which may arise should be 
reduced by leeching, low diet, rest, &c. Pain may be 
allayed by proper doses of laudanum or Dover's powder. 

If the wound has penetrated the abdomen, aud any part 
of the bowel protrudes, if clean and uninjured, return it as 
quickly as possible ; if covered with dirt, clots of blood, &c, 
wash it carefully in warm water previous to so doing. 

If the bowel is wounded, and only cut partly through, 
draw the edges of it together by a stitch, and return it ; if 
completely divided, connect the edges by four or six stitches, 
at equal distances, and replace it in the abdomen. The 
external wound may be closed by adhesive plaster or .stitch- 
es. These wounds are always serious, very often fatal, and 
a surgeon should be obtained, if possible, to take charge of 
the patient at once. The nature of such cases admits of no 
delay. 

WOUNDS OF THE JOINTS. 

Wounds of the joints are always serious, and demand 
proper and close attention. The edges of the wound should 
be kept together by adhesive plaster or stitches, and the 
part should be kept perfectly at rest. If much inflammation 
exists, leeching, low diet, purging, and opiates will be re- 
quired. If a Avound has penetrated a joint, so as to allow the 
synovial fluid to escape, permanent stiffening will be likely 
to ensue ; and, in such cases, the limb should be kept in that 
position which will prove most useful ; that is, the leg should 
be kept extended or straight, and the arm bent at the elbow, 
so that the hand will cover the navel. 



POISONED WOUNDS. 243 



WOUNDS OF THE TENDONS. 



Tendons, or " sinews," are occasionally wounded and 
ruptured. They may be treated precisely like any other 
wound, by keeping the divided parts together. The tendon 
which connects the great muscles forming the calf of the leg 
with the heel, called the tendon of Achilles, is occasionally 
cut with the adze, and ruptured in jumping from heights. 
These accidents are to be treated by drawing up the heel, 
extending the foot, and placing a splint on the fore part of 
the leg, extending from the knee to beyond the toes, which, 
being secured in that position by a bandage, keeps the foot 
in the position first mentioned. The hollow under the splint 
should be filled up with tow or cotton. If the skin falls into 
the space between the ends of the tendon, apply a piece of 
adhesive plaster to draw it out of the way. It takes five or 
six weeks to unite, but no weight should be borne on the 
limb for several months. 



. POISONED WOUNDS. 

FROM BITES OF MAD DOGS, RATTLESNAKES, ETC. 

Treatment. Without hesitation or delay, cut out the 
parts bitten, taking along with them a portion of the sur- 
rounding sound flesh ; bathe the wound in hot water, to 
encourage bleeding for a few minutes, and then thoroughly 
cauterize with nitrate of silver. 

Should the patient be too timid to allow the use of the 
knife, burn the wound very freely with the caustic, and 
place in it a tuft of tow or cotton, well moistened with tur- 
pentine. The discharge of matter which follows should be 
kept up for several days, The only reasonable chance of 
safety is found in the above plan. 

What is called the Western cure for the bite of the rattle- 
snake, consists in making the patient drunk ; and very large 



244 MEDICAL AND SURGICAL COMPANION. 

quantities of spirit are required. Vomiting of bile seems to 
be a favorable symptom and effort to expel the poison, and 
may be treated by more spirit, and by a mustard poultice to 
the pit of the stomat-h. 

Never neglect the cutting and cauterizing in the hope that 
other measures may answer, for they are of very doubtful 
efficacy. 

STINGS OF BEES AND WASPS, BITES OF MOSQUITOS, ETC. 

If the stings are left in, extract them with a fine forceps; 
then bathe with diluted aqua ammonia, cologne water, spirit 
of camphor, salt water, vinegar, or volatile liniment. Mos- 
quito bites are quickly relieved by applying a solution of 
common salt in water ; but any of the above-mentioned arti- 
cles are good. 

To prevent mosquitos from biting, use the following 
mixture : — 

Take of Oil of Pennyroyal, . . .2 drachms, 

Glycerine, . ... 2 drachms, 

Spirit of Camphor, . . 1 J ounces. 

Mix. Apply to the face and hands every second or third 
hour, or as often as necessary. 

FRACTURES. 

Fractures (broken bones) are known by the sudden and 
severe pain ; by the misshapen appearance of the limb ; 
sometimes by its being shortened ; by the patient being 
unable to move it without excruciating pain, — but most cer- 
tainly by grasping the limb above and below the spot where 
the fracture is supposed to be, and twisting it different ways, 
when a grating (crepitus) will be felt, occasioned by the 
broken ends of the bone rubbing against each other. If the 
swelling, however, is very great, this experiment should not 
be made until it is reduced. 



FRACTURE OF THE COLLAR BONE. 245 
FRACTURE OF THE BONES OF THE NOSE. 

The bones of the nose, from their exposed situation, are 
frequently forced in or broken. To treat the injury, any 
smooth article, which will pass into the nostrils, should be 
immediately introduced with one hand, to raise the depressed 
portions to their proper place, while the other hand is em- 
ployed in moulding the nose into its original shape. If 
there is much bleeding, check it by applying or injecting 
cold water, to which a little tannin or alum may be added. 
Powdered matico leaves, used as a snuff, will often speedily 
arrest the hemorrhage. If inflammation follow, apply cold 
lotions. 

FRACTURE OF THE LOWER JAW. 

This accident may be readily detected by looking into the 
mouth, or by passing one or two fingers along the teeth, the 
thumb being applied outside. The injury is to be remedied 
by keeping the lower jaw firmly pressed against the upper 
one, by means of a bandage passed under the chin and over 
the head. If it is broken near the angle, or that part near- 
est the ear, place a cushion or roll of linen in the hollow 
behind it, over which the bandage must pass, so as to make 
it push that part of the bone forward. The parts should be 
confined in this way for about three weeks, during which 
time all the nourishment that is taken should be sucked 
between the teeth. If, in consequence of the blow or injury 
a tooth is loosened, do not disturb it, for if let alone it 
will probably grow fast again. 

FRACTURE OF THE COLLAR BONE. 

This accident is a very common occurrence, and is known 
at once by passing the finger along it, and by the swelling 
and tenderness at the point of injury. To reduce it, seat the 
patient on a chair, remove the shirt, and place under the arm 
a firm roll of linen or other substance, made in the form of 
a wedge, the thick end of which should press against the 



246 MEDICAL AND SURGICAL COMPANION. 

arm-pit. This arm, bent to a right angle at the elbow, is 
now to be brought down to the side, and secured in that posi- 
tion by a long bandage, which passes over the arm of the 
affected side and round the body. The fore-arm (that part 
reaching from the elbow to the wrist) is to be supported 
across the breast by a sling. The wedge-shaped compress 
in the arm-pit may be held in its place by a piece of wide 
tape, passed over the shoulder of the opposite side, the ends 
being sewed to the upper part of the compress, one before 
and the other behind. It takes four to five weeks for this 
bone to re-unite. 

FRACTURE OF THE ARM. 

Seat the patient on a chair, or the side of a bed ; let an 
assistant hold the sound arm, and keep the body of the 
patient steady, while another grasps the wrist of the broken 
one, and steadily extends it in an opposite direction, bending 
the fore-arm a little, to serve as a lever. You can now place 
the bones in their proper situation. Two splints of shingle, 
or stout pasteboard, long enough to reach from just below 
the shoulder to near the elbow, may then be well padded 
with cotton or tow, and laid along each side of the arm, and 
kept in that position by a bandage. The fore-arm is to be 
supported in a sling. For greater security we sometimes 
put two shorter splints between the first ones ; that is, one 
on top, and the other underneath the arm. 

Before applying the splints, the hand and fore-arm should 
be well and evenly bandaged, to prevent oedema or swelling. 
At the end of five or six weeks the patient may be allowed 
to swing the arm gently backwards and forwards, and grad- 
ually to bring it into use. 

FRACTURE OF THE BONES OF THE FORE-ARM. 

Let one assistant grasp the arm just above the elbow, and 
hold it firmly, while another takes hold of the hand or wrist, 
and makes gentle but firm extension, the thumb being up- 



FRACTURE OF THE RIBS. 247 

wards. You are now to apply a splint to the inner side, 
reaching from near the elbow to the ends of the fingers. An 
outside splint, reaching from near the elbow to the back of 
the wrist may also be applied. Both splints should be wide 
enough, and should be padded along their middle. They 
should be kept in place by a bandage, and the arm placed 
in a sling. The cure is usually complete in four to six 
weeks. 

FRACTURE OF THE WRIST, ETC. 

This accident is of rare occurrence. When it does hap- 
pen, the injury is often so great as to require amputation. 
If an attempt be made to save the hand, lay it on a splint 
well covered with tow or cotton ; the splint to extend a little 
beyond the fingers. Place another splint opposite to it, 
lined with the same soft material, and secure them by a 
bandage. 

The bones of the hand are sometimes broken. When this 
is the case, fill the palm with a soft compress of tow or cot- 
ton, and then lay a splint on it, long enough to extend from 
the elbow to beyond the ends of the fingers, to be secured by 
a bandage, as usual. 

When a finger is broken, extend the end of it until it be- 
comes straight, place the fractured portion in its proper 
position, and then apply two small pasteboard splints, one 
below and the other above, to be secured by a narrow 
bandage. The top splint should extend from the end of the 
finger over the back of the hand. Recovery generally takes 
place in two or three weeks. 

FRACTURE OF THE RIBS. 

When, after a fall or blow, the patient complains of a 
pricking pain in his side, we may suspect a rib is broken. 
It is ascertained by placing the tips of two or three fingers 
on the spot where pain is felt, and desiring the patient to 
cough, when the grating sensation may be felt ; and there 
will be tenderness at that poiut. All that is necessary is to 



248 MEDICAL AND SURGICAL COMPANION. 

pass a broad bandage round the chest, so tight as to prevent 
the motion of the ribs in breathing, and to keep the patient 
quiet, and on a low diet. 

FRACTURE OF THE THIGH. 

A fracture of this bone is generally known by the deformity 
of the thigh, the shortness of the whole limb when compared 
with its fellow, and by the swelling at the point of the frac- 
ture. This is a serious accident, and the nearest regular 
physician should be called. Keep the patient quiet, with the 
limb as nearly in its natural position as possible, until he 



FRACTURE OF THE KNEE-rAN. 

This accident is easily ascertained on inspection. It may 
be broken in any direction, but is most generally so across or 
transversely. It is reduced by bringing the fragments to- 
gether, and keeping them in thai position by a long bandage 
passed carefully round the leg, from the ankle to the knee ; 
then pressing the upper fragment down so as to meet its 
fellow (the leg being extended), a thick compress of linen 
is placed above it, over which the bandage is to be continued. 
The extended limb is now to be laid on a board splint, ex- 
tending from the upper part of the thigh to the heel, thickly 
covered with tow, cotton, or soft old linen, to till up the 
inequalities of the leg. For additional security, two strips 
of cloth may be nailed to the middle of the splint, one on 
each side, and passed about the joint, the one below, the 
other above, so as to form a figure of eight. In twenty or 
thirty days the limb should be moved a little, to prevent 
stiffness. 

If the fracture is through its length, bring the parts to- 
gether, place a compress on each side, and keep them togeth- 
er with a bandage, leaving the limb extended and at rest. 
Any inflammation in this or other fracture is to be reduced 
by low diet, purging, cooling applications, leeching, &c. 









FRACTURE OF THE BONES OF THE FEET. 249 



FRACTURE OF THE LEG. 

From the thinness of the parts covering the principal 
bone of the leg, it is easy to ascertain if it is broken oblique- 
ly. If, however, the fracture be directly across, no displace- 
ment will occur ; but the pain, swelling, and the grating 
sensation will sufficiently decide the nature of the accident. 
If the fracture is oblique, let two assistants extend the limb, 
while you place the broken parts in their natural position. 
Two splints, that reach from a little above the knee to nine 
or ten inches below the foot, — having near the upper end of 
each four holes, and a vertical mortise near the lower end, 
into which is fitted a cross-piece, — are now to be applied as 
follows : Lay two pieces of tape, about a foot and half long, 
on each side of the leg, just below the knee joint, and secure 
them there by several turns of a bandage ; pass a silk hand- 
kerchief, or some such article round the ankle, cross it on 
the instep, and tie it under the sole of the foot. The two 
splints are now placed, one on each side of the leg, the four 
ends of the pieces of tape passed through the four holes and 
firmly tied, and the cross-piece placed in the mortise. By 
tying the ends of the handkerchief to this cross-piece the 
business is finished. Rest for four or six weeks will be 
necessary. 



FRACTURE OF THE BONES OF THE FEET. 



The bone of the heel (os calcis) is sometimes, though 
rarely, broken. It is known by a crack at the moment of 
the accident, a difficulty in standing, by the swelling, and by 
the grating noise on moving the heel. To reduce it, take a 
long bandage, lay the end of it on top of the foot, carry it 
over the toes, under the sole, and then, by several turns, 
secure it in that position. The foot being extended as much 
as possible, carry the bandage along the back of the leg 
abov« the knee, where it is to be secured by several turns, 
and then brought down on the front of the leg, to which it is 



250 MEDICAL AND SURGICAL COMPANION. 

to be secured by circular turns. In this way the broken 
pieces will be kept in contact, and in the course of a month 
or six weeks, will be united. 

Fractures of the foot, toes, &c, are to be treated like those 
of the hand. 

DISLOCATIONS. 

Dislocations, or bones being out of joint, are known by 
the deformity of the joint, when compared with its fellow ; 
by the pain and inability to move the limb ; by its being 
longer or shorter than usual, and by the impossibility of 
moving it in particular directions. The sooner the attempt 
is made to reduce a dislocated bone, the easier it will be 
done. 

DISLOCATION OF THE LOWER JAW. 

This accident, which is occasioned by blows, or yawning, 
is known by an inability to shut the mouth, and the projec- 
tion of the chin. To reduce it, seat the patient on a chair, 
with his head supported by the breast of an assistant, who 
stands behind him. Your thumbs being covered, are then 
to be pushed between the jaws, as far back as possible ; then, 
while you bear down upon the last molar or double teeth 
with your thumbs, press up the chin with your lingers, and 
the bone will snap into its place. 

DISLOCATION OF THE COLLAR BONE (CLAVICLE). 

This bone is rarely dislocated. Should it occur, apply the 
bandages, &c, directed for a fracture of the same part. 

DISLOCATION OF THE SHOULDER. 

Dislocation of the shoulder is the most common of all 
accidents of the kind. It is very easily known by the defor- 
mity of the joint, and the head of the bone being in most 
cases found in the armpit ; the elbow is carried out some 
inches from the body, and more or less rigidly fixed ; the 



DISLOCATIONS. 251 

arm being slightly lengthened. To reduce it, place the 
patient upon a bed or on the floor. Place one heel in the 
armpit, against the head of the bone. Then, taking hold 
of the arm above the elbow, or at the wrist, pull steadily, 
and while so doing, work the head of the bone outwards 
into the socket. If not easily reduced, give ether to relax 
the muscles ; then try again. 

Should the head of the bone be found in any other posi- 
tion than in the armpit (axilla), have an assistant pull 
steadily upon the arm, and move it in the direction which it 
can be moved easiest, while you assist in working the head 
of the bone into its proper position. 

In all cases of dislocation, as well as of fracture, call a 
surgeon, if one is obtainable. 

DISLOCATION Or THE ELBOW. 

If the patient has fallen on his hands, or holds his arm 
bent at the elbow, and every endeavor to straighten it gives 
him pain, it is dislocated backwards. Seat him on a chair, 
and let an assistant grasp the arm just above the elbow, and 
pull it backwards, while, by grasping the wrist, you pull the 
bone forwards into place. The arm should be placed in a 
sling for a few days. 

If dislocated sideways, let two assistants make traction, in 
the manner just stated, while you push the bones into their 
natural position. 

DISLOCATION OF THE WRIST, FINGERS, ETC. 

Dislocations of the wrist, fingers, and thumb are readily 
perceived on examination. They are all to be reduced by 
forcibly extending the lower extremity of the 'part, and 
pressing the bones into their places. These accidents should 
be attended to without delay. 

DISLOCATION OF THE HIP. 

Send for a surgeon as soon as possible. Do the same in 
dislocation at the knee joint. 



252 MEDICAL AND SURGICAL COMPANION. 



DISLOCATION OF THE ANKLE. 

The ankle may be dislocated in various ways. Attempt 
reduction as early as possible, by means of extension and 
oounter-exteusion, made with the hands, the foot being at 
the same time flexed, extended, and moved in various direc- 
tions, while direct pressure is exerted to force the bone into 
place. 

DISLOCATION OF THE SMALLER BONES OF THE FOOT. 

These, when recognized, may sometimes be corrected, 
without any great difficulty, by direct pressure. They are 
to be dealt with on the same principle as those of the cor- 
responding bones of the hand. 



SPRAINS. 

Sprains are injuries done to the ligaments, tendons, and 
other structures surrounding the joints. They are produced 
by jumping, falling, or other causes which forcibly stretch 
or lacerate them. The joints most liable to sprains are the 
wrist and ankle joints : the wrist joint becomes sprained in 
consequence of the arms being naturally thrown out by per- 
sons in falling, to prevent their being seriously injured, by 
which means the whole weight of the body is thrown on the 
wrists, which not only sprains these joints, but sometimes 
fractures them. The ankle joint is frequently sprained by 
jumping from a considerable height, or the foot turning 
under the weight of the body. Sprains are attended with 
great pain at the time of the accident, and also with consid- 
erable swelling and discoloration, arising from the effusion 
of blood into the surrounding structures. The joints at first 
can be easily moved, but as the swelling and inflammation 
increase, all motions become painful, and the patient cannot 
use the injured joint without increasing the trouble. After 



SPRAINS. BRUISES. 253 

a severe sprain of the ankle joint, it will be several weeks, 
and in some cases several months, before full weight can be 
borne upon it. Such injuries improve very slowly. 

Treatment. Rest and time are important in the treat- 
ment of these injuries. During the inflammatory stage, 
when the part is swollen and painful, it should not only 
be kept at rest, but in an elevated position, and a cooling 
lotion should be kept constantly applied. Cloths, saturat- 
ed with the following lotion, should be applied, and renewed 
as often as they become warm. 

Take of Acetate of Lead . . .1 drachm, 
Water, 1 pint. 

Mix. This practice should be continued for the first day 
or two ; after which, should the swelling or pain increase, 
leeches may be applied to the parts affected, and the bleed- 
ing freely encouraged by means of a sponge and warm 
water constantly applied to the leech-bites. Hot fomenta- 
tions should afterwards be applied, by means of flannels, 
wrung out of a decoction of poppy-heads ; and the bowels 
kept in a free state by Epsom salts. By this treatment the 
inflammation will generally rapidly subside, and the parts 
return to their usual healthy condition in persons of sound 
health. The patient should not be allowed to make use of 
his limb too soon, as the irritation and inflammation of the 
joint will thereby be kept up, and thus he may suffer from 
it for months or even years. When all signs of the trouble 
have disappeared, the motions of the part may be promoted 
by gentle exercise, and the use of the volatile liniment, 
night and morning. 



BRUISES. 

A bruise or contusion signifies an injury inflicted by some 
blunt object, without breaking the skin. 



254 MEDICAL AND SURGICAL COMPANION. 

Treatment. If the bruise be a bad one, the injured part 
should, if possible, be placed in a raised position, and cold 
water freely applied. Should the part become very much 
swollen and painful, leeches may be applied. These meas- 
ures, together with rest, moderate purgatives, and a rather 
light diet, will generally prove sufficient to check extravasa- 
tion of blood, and prevent or subdue inflammation. After 
inflammation and tenderness have subsided, the part may be 
rubbed with stimulating liniments, to produce absorption of 
the effused fluids, and restore the use of the parts. 



BURNS AND SCALDS. 

Extensive burns or scalds, even of small severity, are 
always dangerous ; and especially if blistering has occurred 
early, and the cuticle has been removed. Burns on the 
trunk are always more dangerous than those of an equal 
extent on the extremities. 

Treatment. In slight cases a little glycerine will be 
found as good as anything, and even in quite severe and 
extensive burns, if enough of it be at hand, it will be found 
equal if not superior to almost any other article. Sweet 
oil or linseed oil may be used, when glycerine is not ob- 
tainable. A liniment, composed of equal parts of lime-water 
and linseed or sweet oil, is excellent. After any of the 
above articles have been applied, the parts burned should 
be wrapped in cotton wool. 

Should the burn be very extensive, and the patient very 
much prostrated in consequence, brandy, beef tea, and milk 
should be given. If the pain be very great, laudanum may 
be given with caution, to produce relief. In all extensive 
burns, call a physician as soon as possible, if one can be 
obtained. 



CONCUSSION OF THE BRAIN. 255 



CONCUSSION OF THE BRAIN. 

Concussion of the brain (commonly called stunning), sig- 
nifies sudden interruption of the functions of the brain, caused 
by a blow, fall, or other mechanical injury to the head. 

Symptoms. In ordinary cases the patient lies for a time 
motionless and insensible. After a time he moves his limbs 
as if in uneasy sleep, and vomits, and frequently recovers 
his senses immediately afterwards ; remaining, however, 
giddy, confused, and sleepy, for some hours. In more severe 
cases, the patient is profoundly insensible, the surface pale 
and cold, the features ghastly, the pulse feeble and inter- 
mittent, and the breathing slow, or performed only by a 
feeble sigh, drawn at intervals. 

Vomiting is an important symptom, not present in very 
slight, nor in very severe cases. Its occurrence is generally 
an indication of approaching recovery. 

Treatment. Rub the surface of the body with the hand, 
and apply warmth to the feet, if the depression is very 
great. It is better, in most cases, to leave the patient to 
recover by himself, than to be officious in giving stimulants, 
as they would increase the effusion of blood, supposing the 
brain to be lacerated. In these cases it is improper to put 
strong drinks into the patient's mouth, for he cannot swallow ; 
and if he should be so far recovered as to make the attempt, 
they might, probably, enter the windpipe and cause strangu- 
lation. It is also improper to bleed him, for the blood can- 
not flow until he begins to recover, and then its loss might 
destroy him, by inducing fatal prostration. Smelling salts 
or ammonia may be held to the nostrils, but only for a few 
seconds at a time. It is better to have a little patience in 
these cases, for by haste and much dosing we may do harm 
rather than good. 

After reaction has taken place, the bowels should be 
freely moved, and perfect rest and low diet observed. 



256 MEDICAL AND SURGICAL COMPANION. 



COMPRESSION OF THE BRAIN. 

If from a blow, fall, or other injury, the skull is frac- 
tured, and portions of bone depressed, causing compression 
of the brain, procure surgical assistance, if possible, without 
delay, as there is nothing but an operation that can be of 
any avail. In these cases the patient generally lays sense- 
less and motionless ; his breathing slow, noisy, and labori- 
ous ; the pupil of his eye enlarged, and will not coutract, 
even by a strong light, and his muscles are relaxed as in a 
person just dead. 



BLEEDING FROM THE NOSE. (Epistaxis.) 

Causes. Fulness of blood, violent exercise, peculiar posi- 
tions of the body, blows, &c. 

Treatment. Keep the patient erect, or sitting with his 
head thrown a little backwards ; take off his cravat, unbut- 
ton his shirt collar, and expose him freely to the cold air ; 
apply cold water to the face and back of the neck. If these 
measures are not sufficient, moisten a long plug of cotton 
with water, then roll it in powdered matico leaves, tannin, 
or alum, aud work it up the nostril. 

In very obstinate cases, a small elastic catheter or bougie 
may be passed through the nostril, into the throat, drawn 
out at the mouth, and a bit of fine sponge be fastened to it, 
and drawn back again, so as to make the sponge block up 
the posterior nostril. In doing this it is necessary to leave 
a piece of the string, used in tying the sponge to the cathe- 
ter, hanging in the throat, so as to be got hold of, in order 
to withdraw the sponge, which should, in most cases, be 
removed in a day or two. After plugging the posterior 
nostril with the sponge, the nostril should be well stopped 
up in front with cotton or lint. 



RUPTURES. 257 



COMPOUND ACCIDENTS. 

Having spoken of .the treatment to be pnrsued for a wound, 
fracture, dislocation, &c, as happening singly, it remains 
to be stated what is to be done when they are united. 

We will suppose that a man has been violently thrown 
from a carriage. On examination, a wound is found in his 
thigh, bleeding profusely ; his ankle is out of joint, with a 
Avound communicating with its cavity, and the leg is broken. 
In the first place, stop the bleeding from the wound in the 
thigh ; reduce the dislocation next ; draw the edges of the 
wounds together with adhesive plaster, and procure a sur- 
geon as quickly as possible. If, instead of wounds, fracture, 
and dislocation, there is concussion of the brain, a disloca- 
tion and fracture, attend to the concussion first, the disloca- 
tion next, and lastly the fracture. 

AMPUTATION. 

Amputation, or the cutting off of limbs, should never be 
attempted except by a surgeon. If a limb be nearly severed 
from the body by accident, and hang merely by a slip of 
skin or muscle, it may be divided with a sharp knife. 

RUPTURES. {Hernia.) 

Ruptures are indicated by tumors or swellings caused by 
the protrusion of some part of the bowels through certain 
natural openings. They are divided into reducible, irredu- 
cible, and strangulated. They mostly occur in men, in the 
groin and scrotum. 

Causes. Straining in any way; vomiting; lifting heavy 
weights ; violent exercise, as jumping, running, &c. ; weak- 
ness of the parts. 
17 



258 MEDICAL AND SURGICAL COMPANION. 



REDUCIBLE RUPTURES. 

Symptoms. A small swelling, free from pain, and gener- 
ally soft, the color of the skin over it remaining unaltered. 
While standing up the swelling increases ; on lying down 
it decreases, the patient being able to return the parts him- 
self while in that position. 

The swelling is also increased by coughing, sneezing, or 
straining. If he is flatulent, a rumbling sensation may be 
felt in it. 

Treatment. The patient should place himself on his 
back, with his hips a little elevated, draw up his knees to 
his abdomen, and if the parts do not return of themselves, 
endeavor to push or knead them up into the abdomen, 
through the opening at which they came out, and which, if 
the tumor be in the groin or scrotum, is an oval ring or slit 
in the groin, at the precise spot where the swelling first ap- 
peared. When this is effected, he should remain quiet until 
a truss can be procured, the spring of which must be passed 
round his body, and the pad be applied directly over the 
spot first mentioned. It should be worn sufficiently tight to 
prevent the escape of the bowels again. After the truss 
has been applied, it will be well to have the patient get up 
and walk about, when, if the swelling does not reappear, 
the truss is properly applied ; if otherwise, take it off, retura 
the parts as before, and apply it again ; if then, on rising, 
walking about, coughing, &c, the parts are found to be well 
kept up, he may resume his ordinary business. The truss 
should be always worn during the day, and in some cases 
during the night. 

IRREDUCIBLE RUPTURES. 

Symptoms. A rupture in which there is no pain, yet 
that cannot be returned into the abdomen, in consequence of 
an increased bulk of the parts, or their having formed adhe- 
sions, or grown fast to adjoining parts. 



STRANGULATED RUPTURES. 259 

Treatment. Apply a hollow bag truss, or else a truss 
with a hollow pad that shall firmly embrace the tumor, and 
prevent any additional protrusion. The patient should avoid 
all violent exertion, or excess in diet, and should never let 
his bowels be confined. 

STRANGULATED RUPTURES. 

A rupture is said to be strangulated, when it is constricted 
in such a way that the contents of the bowels cannot be pro- 
pelled onwards, and the return of its venous blood is im- 
peded. 

Symptoms. The patient first complains of flatulence, 
colicky pains, a sense of tightness across the belly, desire 
to go to stool, and inability to evacuate. Stools may, how- 
ever, be passed, if there be any fecal matter in the bowel, 
below the hernia, but with very transient relief. To these 
symptoms succeed vomiting of the contents of the stomach, 
then of mucus and bile, and, lastly, of matters which have 
acquired a fecal appearance, by being delayed in the small 
intestines. There is often considerable diversity in the 
rapidity and violence of the symptoms. If the patient is a 
strong adult, and the strangulation has commenced suddenly, 
with a fresh protrusion during some forcible exertion, in- 
flammation may come on instantly, and the patient be dead 
in a few hours. After inflammation has set in, the tumor 
becomes tender, and the tenderness soon diffuses itself over 
the abdomen, which shortly becomes considerably swelled. 
The countenance is anxious ; the vomiting almost constant ; 
the patient restless and despondent ; and the pulse small, 
hard, and wiry. After a variable time, if relief is not ob- 
taiued, the constricted parts begin to mortify ; the skin 
becomes cold ; the pulse very rapid and tremulous, and the 
tumor dusky red ; but the pain ceases, and the patient ex- 
presses himself relieved, and dies soon afterwards. 

Treatment. Send immediately for the best medical aid 
which may be within reach. If you are where no physician 



260 MEDICAL AND SURGICAL COMPANION. 

can be obtained, place the patient on his back, with his 
shoulders elevated, and the thighs drawn up towards the 
abdomen ; then apply both hands on the tumor with gentle, 
but gradually increasing pressure ; or grasp the tumor gently, 
but steadily, with one hand, while with the fingers of the 
other you endeavor to Jcnead or push up the parts nearest the 
ring in the groin, applying the pressure in the same course 
the parts have taken in their descent. If this fail, seize 
the tumor between the finger and thumb of the left hand, 
close to where it enters the abdomen, and carry them down 
with a moderate pressure, so as to dislodge auy excrement 
which may be there, while with the right you endeavor to 
push in the bowel. If you cannot succeed, after two or 
three attempts, etherize the patient ; or, if you have no ether 
at hand, place him in a warm bath for a time, and try 
again. 

Cold applied to the tumor, by means of pounded ice, 
snow, or very cold water, will often, by its contracting effect, 
aid us in reducing a strangulated hernia. Raising the 
patient's hips considerably higher than his head, so that the 
contents of the abdomen may gravitate towards the dia- 
phragm, will usually aid us very much in our efforts to return 
the bowels. If, after making all proper efforts to relieve the 
patient, we are unsuccessful, nothing but an operation will 
save the patient, and even that may not if delayed too long. 



OBSTRUCTIONS IN THE THROAT. 261 



CHAPTER II. 

REMOVAL OF FOREIGN BODIES, BLOOD- 
LETTING, &c. 

REMOVAL OF FOREIGN BODIES FROM THE 
THROAT. 

Fish-bones, pins, &c, occasionally stick in the throat, 
and cause much annoyance. The moment an accident of 
this kind occurs, desire the patient to be perfectly quiet, 
open his mouth, and look into it. If you can see the ob- 
struction, endeavor to seize it with your finger and thumb, 
or a slender pair of forceps. If it cannot be removed in 
this way, and is not of a nature to do injury in the stomach, 
push it down with a flexible round piece of whalebone, the 
end of which is neatly covered with a roll of linen. If the 
obstruction be a slight affair, but one which cannot be 
reached easily, swallowing some pieces of dry bread or 
cracker may take it down. In some cases an emetic will 
cause it to be thrown out. 

Persons are sometimes choked by attempting to swallow 
a large or half-chewed mouthful. If, on opening the mouth, 
the source of choking can be seen, remove by the fingers 
or forceps, or push it down into the stomach if possible. 
Sometimes it may be washed down with a draught of water. 
Money, buttons, and other articles are sometimes swallowed, 
and usually pass through the bowels without difficulty. If 
the coin be copper, avoid taking vinegar or other acids until 
it has passed the bowels. 



2G2 MEDICAL AND SURGICAL COMPANION. 

Foreign bodies sometimes escape into the windpipe when 
a person is speaking or laughing with food or other sub- 
stances in the mouth. In such cases a violent and distress- 
ing fit of coughing results, during which small, light articles 
are frequently expelled, and the trouble is over. 

Treatment. Place the patient's head downwards, or con- 
siderably lower than the body, and then slap him smartly 
across the back several times to increase the expulsive 
efforts of the lungs. If the article is not quickly removed, 
send for a surgeon without delay, for an operation may be 
required to save the patient. 

REMOVAL OF FOREIGN BODIES FROM THE NOSE AND EARS. 

Children often amuse themselves with poking things with 
which they are at play into their noses and ears. If peas, 
beans, or any other seed or substance be thrust in, which 
swell as they moisten, no time should be lost in getting 
them out ; otherwise, as they enlarge, they become more 
firmly fixed and more difficult to be removed, are attended 
with greater pain and suffering, and may even cause dan- 
gerous consequences. Hard substances, as shells, beads, 
&c., which remain unchanged in bulk by moisture, are of 
less consequence, and may remain some days without caus- 
ing much inconvenience, and often drop out of themselves. 

If the pea or shell be in the nostril, the child should be 
made to draw his breath in deeply, and then stopping the 
other nostril with the finger, and closing the mouth firmly, 
to blow forcibly through that side of the nose in which the 
substance is lodged. If this be done soon after the acci- 
dent, two or three efforts usually shoot the unwelcome lodger 
out. But if this does not succeed, the nose must be tightly 
nipped with the finger and thumb, above the pea or shell, so 
as to prevent it getting farther in, and then the eyed end of 
a bodkin or probe, having been a little bent, must be gently 
insinuated between the bottom of the nose and the sub- 
stance, and when introduced sufficiently far, must be gently 



REMOVAL OF FOREIGN BODIES. 263 

used as a hook to bring it down. Pushing it back into the 
throat should not be tried, as not unfrequently so doing only 
fixes it the more firmly. If a physician be within reach, it 
is better at once, if the substances cannot be snorted or 
blown out, to take the child to him, as he will be able to 
manage the matter better and more readily the earlier he 
is applied to. If any swellable body, as a pea or bean, has 
been lodged in the ear, do not go to syringing with water or 
any other fluid, as it will excite the substance to swell, and 
increase the mischief. In such cases, if the body has passed 
out of sight, a physician should be immediately sent for. 

If a hard body, as a shell, or button, or bead, be pushed 
into the ear, syringing with water may be used with ad- 
vantage, as, if the water pass in any way between the hard 
body and the ear-drum, it will not unfrequently force it 
out. The head should be laid down, so that the ear, in 
which the hard body is, be undermost, and in this position 
the water should be thrown up with the syringe, the nozzle 
of which, however, must be held at some little distance, 
and not put into the pipe of the ear, or it will prevent the 
hard body dropping out. Whilst the head is thus laid, it 
should be shaken a little, which may cause the offender to 
drop out. 

Never poke about in the ear if there be doubt of anything 
being there lodged. Unless it can be distinctly seen, this 
should always be avoided. 

Insects sometimes, though rarely, get into the ear. The 
best method to dislodge them is to wash or syringe out 
the ear with warm water, or salt and water, or to fill it 
with sweet oil or glycerine, which will kill the animal, 
and cause it to float out. The ears sometimes become 
loaded with dry wax, causing partial deafness, and odd 
uoi.ses, &c, to be heard. Syringing once or twice a day 
with simple warm water will generally answer. A little 
warm glycerine may be dropped in every night to soften 
the wax. 



264 MEDICAL AND SURGICAL COMPANION. 



REMOVAL OF FOREIGN BODIES FROM THE EYE. 

Things of various kinds occasionally get into the eye, as 
it is commonly called, not meaning thereby that they get 
into the eyeball itself, though this indeed sometimes hap- 
pens, but only that they get within the eyelids, between them 
and the ball. A small fly may dash in, or road sand, 
small pieces of straw or soot, or any other small body may 
be driven in by a gust of wind ; or, whilst grinding a steel 
instrument, a delicate fragment may be thrown up by the 
wheel into the eye. If the body be soft, or if it have not 
beeu darted in with much violence, it rarely fixes on the 
globe, but is quickly transferred from it to the inside of one 
of the lids, generally of the upper, so that it is not at first 
perceived, and its preseuce only supposed in consequence of 
the uneasy feeling and the free discharge of tears, which 
are secreted in great abundance, as a natural effort to wash 
the offender out. If, however, it be driven with violcuce, 
it beds itself more or less deeply and firmly iu the surface 
of the eyeball, and cau tlieu be seeu as well as felt when the 
lids are opened. 

Treatment. The most simple plan is to keep the eyelids 
closed, aud then gently pass the finger over them from the 
outer to the inner corner. After thus passing the finger a 
few times, the little substance is often found at the inner 
corner of the eye, and may be wiped out with the handker- 
chief or with the finger. 

Another and very good method, if the lodgment be either 
on the eyeball or Avithin the upper lid, is to take hold of the 
eyelashes of the upper lid and lift it completely over the 
lower, the lashes of which, being thus interposed between 
the upper lid and the eyeball, serve as a delicate brush, and 
entangling the substance bring it out with them, when the 
upper lid recovers its place. Should neither of these 
methods, however, produce any relief ; if the uneasiness and 
watering of the eye continue, then it is better to obtain the 



BLOOD-LETTING. 265 

precise situation of the intruder so as to act more efficiently 
on it. For this purpose, with the finger gently draw down 
the lower eyelid, which will completely expose its inner sur- 
face, and the whole lower part of the eyeball, both of which 
are to be examined. 

To look at the upper lid, which requires being turned 
inside out, is more difficult, but may be done with gentle- 
ness, and a little dexterity, in the following way : With the 
fingers and thumb of one hand take hold of the lashes of 
the upper eyelid, and pull it forward from the globe ; then, 
with the other, lay the blunt end of a bodkin, knitting 
needle, probe, or pen-handle upon its outer surface, and 
press down gently, at the same time lifting the lashes to- 
wards the eyebrow. This turns the inside of the lid out, 
and it may then be well examined. 

If the little substance be found unfixed, wrap a silk hand- 
kerchief over the finger, and brush it away. A camel's- 
hair brush is often of service in brushing small, loose objects 
from the eye. 

If a piece of steel, or other substance, is sticking in the 
eyeball, so that it cannot be brushed out by gentle means, 
apply to a physician without delay. 

To remove particles of lime or mortar, the lids should be 
everted, and the eye be well syringed or sponged with weak 
vinegar and water, or with oil, or with pure water if neither 
be at hand. 

For injuries with acids or alkalies, free washing or 
syringing with water is the readiest remedy. 



BLOOD-LETTING. 

To reduce excessive inflammation, whether arising from 
disease or wounds, blood-letting often proves beneficial. At 
the present day general blood-letting is seldom resorted to — 
cupping or leeching answering as well or better in most 



266 . MEDICAL AND SURGICAL COMPANION. 



GENERAL BLOOD-LETTING. 

If we take blood from a vein at the bend of the arm, 
or on the top of the foot, it is termed general blood-lettiug. 
When plethoric individuals are attacked with apoplexy or 
pleurisy, it may prove beneficial. 

How to bleed from thk foot. Tie a piece of tape 
tightly round the leg immediately below the knee ; soon after 
which the veins on the top of the foot will swell up ; if they 
do not, the foot may be put into hot water, which will very 
soon cause them to swell sufficiently. Of these select the 
largest, which may be opened by pushing the lancet oblique- 
ly into the vein, and making it cut its way directly outwards. 
When the quantity of blood desired has been obtained, take 
off the tape, and let the patient lie down at full length, and 
close the wound with a pad of lint and a strip of adhesive 
plaster. 

From the bend of the arm. Tie a handkerchief, 
tape, or cord around the arm, at least two inches above the 
projections of the elbow joint, and then feel for the pulse at 
the wrist. If it cannot be felt, the bandage is too tight, and 
must be relaxed a little. Select the most prominent vein, 
and feel with the tip of your finger if an artery lies near it. 
If you feel one beating so close to it that you are afraid of 
wounding it, choose another. Having selected the vein, 
prevent it rolling about by making pressure on it by the left 
hand thumb, and taking the lancet between the fingers and 
thumb of the right hand, and holding it in a slanting direc- 
tion, make a free incision into the vein ; this done, if the 
blood does not flow freely, put into the patient's hand a ball, 
or walking-stick, and direct him to grasp it firmly. Having 
taken a sufficient quantity of blood, remove the bandage, and 
place a compress of lint on the wound, aud secure it by a 
strip of adhesive plaster. 1 would not advise any one to 
attempt bleeding in the arm without having been properly 
instructed, for there is always danger, to an unpractised 



LEECHES. CUPPING.. 267 

person, of not merely opening a vein, but also of wounding 
an artery, which is a very serious, and sometimes a fatal 
accident. 

LOCAL BLOOD-LETTING. 

The taking of blood directly from or near an inflamed 
part is termed local blood-letting ; and at the present day this is 
resorted to very much oftener than general blood-letting. 
It is performed by leeching or cupping the part. In cities, 
and wherever leeches can be obtained, they are used oftener 
than cups, but where they cannot be hadj cups are used 
instead. 

LEECHES. 

Leeches should be kept in a cool place, in a glass or 
earthen vessel, partly filled with water (which should be 
changed daily), and be covered with coarse strainer cloth. 

To apply leeches. "Wash the part very clean. Put 
the leech in a clean wineglass, or small bottle, and keep it 
confined over the spot for a few moments. If it will not 
bite, scratch or prick the skin until a little blood exudes. 
After the leeches have filled and dropped off, if you wish to 
encourage the bleeding, apply warm fomentations. 

In applying leeches avoid the seats of large veins. 

To CHECK BLEEDING FROM LEECH-BITES. It Sometimes 

happens that bleeding from the leech-bites continues after we 
have taken a sufficient quantity of blood. In these cases a 
bit of cotton wool may be wet, and then rolled in tannin or 
powdered matico leaves, and bound upon the part. A very 
fine point of lunar caustic inserted in the wound will gen- 
erally check the bleeding. The solution of persulphate of 
iron is excellent. 

CUPPING. 
This operation takes its name from the small glasses, 
shaped like a bell or cup, which are used iu performing it. 
Cupa should never be applied directly to an inflamed por- 
tion of skin, but in the neighborhood of it. As kept in the 



268 MEDICAL AND SURGICAL COMPANION. 

shops, cupping glasses are generally in sets, with a small 
exhausting pump which fits a pipe on the top of each cup. 
Applying the margin of a cup to the skin, the air may be 
pumped out through the tube, and the atmospheric pressure 
on the parts around will cause the portion of skin covered 
by the cup to swell up into it, becoming red and turgid. 
There is a stop-cock on each tube, by closing which the cup 
may be left adhering to the surface. To obtain a flow of 
blood, remove the cup by turning the stop-cock, and allowing 
the air to rush in. Then scarify the swollen area of skin, 
either with a lancet or scarificator, and reapply the cup. 
This may be done as often as seems desirable. 

About an ounce of blood is generally drawn by each cup ; 
but the amount will vary somewhat, according to the vas- 
cularity of the part, the size of the glasses used, the state 
of the blood, &c. It is not very often necessary to apply 
any dressing after cupping ; but if the skin is tender, it 
may be protected by a piece of lint spread with cerate, or 
by a water-dressing, warm or cold, according to the feelings 
of the patient. 

In some cases the cups are used without scarifying the 
part ; it is then called dry cupping. 



DIRECTIONS FOR PASSING CATHETERS. 

Take the penis of the patient near its head between the 
fingers and thumb of your left hand (standing beside him), 
while with your right you introduce the point of the instru- 
ment into the urinary passage, its convex side towards the 
knees ; while you push the catheter down the urethra, en- 
deavor to draw up the penis on it. When you first intro- 
duce it, the handle will of course be near the abdomen of 
the patient, and as it descends will be thrown farther from 
it, until it enters the bladder, which will be known by the 
flow of the urine. If you do not readily succeed in passing 



DIRECTION FOR PASSING CATHETERS. 269 

it, vary your position, or that of the patient, or let the 
patient try it himself. Always remember it is by humoring 
the instrument, and not by violence, that you can succeed. 
The female catliether is shorter and much less curved than 
the male, and is usually passed without much difficulty when 
the patient is lying down. 

Bougies and Sounds are passed, in the same manner as 
catheters. 



270 MEDICAL AND SURGICAL COMPANION. 



CHAPTER III. 

ON SOME DISEASES OP THE EYE 
AND EAR. 

NEAR SIGHT. {Myopia,), 

This arises from too great a convexity of the cornea, or 
of the crystalline lens, or both. This affection is usually 
congenital. Short-sighted people generally have prominent 
eyes. 

Treatment. In confirmed cases, double concave glasses 
or spectacles must be worn ; single eye-glasses are bad. 
The spectacles had better not be worn constantly, but only 
when especially required. 



LONG SIGHT. {Presbyopia.) 

This is one of the earliest indications of advancing years. 
It is caused by changes in the eye, not necessary to mention 
here. 

Double convex spectacles should be used. Where the 
sight is weak, relief will often be obtained by wearing spec- 
tacles with glasses of a neutral tint. 



WEAKNESS OF VISION. {Asthenopia.) 

This is a common affection, especially among the poor 
and ill fed working people of large cities, who lead sedentary 



INFLAMMATION OP THE EYE. STYE. 271 

lives. Children who are confined too closely to their books 
also suffer from it. 

Treatment. Tonics, good nourishing food, relaxation 
from toil, and exercise in the open air. 



INFLAMMATION OF THE EYE. (Ophthalmia.) 

Slight inflammation of the membrane covering the globe 
of the eye, and lining the insides of the eyelids, is not un- 
frequently occurring when the eye has been exposed to a 
current of cold air. The eye waters, feels as if sand were 
in it ; the white part is reddened, and soon after a little 
matter is formed, and on waking in the morning the eye- 
lids are felt glued together. Such is the common condition 
of a slight degree of ophthalmia, which, however, may run on 
and become so severe that the eye may be destroyed by it 
very speedily. 

Treatment. When in the mild form I have mentioned, 
it may usually be remedied by the following eye wash, a 
little of which should be dropped into it three or four times a 
day: — 

Take of Sulphate of Zinc, . . . 4 grains. 

Rose Water, or pure Water, . 2 ounces. 

Mix. 

Should the inflammation be very severe, and the eye pain- 
ful, a leech may be applied about an inch from the outer 
angle of the eye. A small blister, about an inch square, 
may be applied to the same locality when leeches cannot be 
obtained. A green shade to protect the eye from light will 
also be beneficial. 

STYE. (Hordeolum.) 

This is a small, painful boil, at the edge of the eyelid. 
Treatment. Bathe frequently with warm water, or a 



272 ^MEDICAL AND SURGICAL COMPANION. 

warm decoction of poppy heads or leaves. At night a small 
flaxseed poultice may be applied. After it has burst, the 
following ointment may be smeared along the edge of the 
eyelid, every night, on going to bed : — 

Take of Citrine Ointment. . . .2 drachms. 

Spermaceti Ointment, . . 4 drachms. 

Mix well together. 

The bowels should be kept open by laxatives, for a few 
days, and afterwards tonics and alteratives given, as the 
complaint arises in debilitated constitutions. The syrup of 
iodide of iron is a good preparation. An adult may take 
twenty drops, in water, three times a day. Obstinate and 
serious diseases of the eye always require the services of a 
physician, or oculist. 

DIMNESS OF SIGHT. (Amaurosis.) 

Symptoms. The sight is impaired by degrees ; at times 
it is more impaired than at others ; objects may appear 
double, crooked, disfigured, or discolored. Sometimes black 
spots seem floating before the eyes. 

Causes. Long-continued exertion of the eye on minute 
objects ; exposure to glaring light, and anything which over- 
taxes the eye. 

Treatment. Avoid the causes which have produced it, 
and consult a physician as soon as convenient. If you 
tamper much with the eye, you may make matters worse 
instead of better. 

CATARACT. 

This is a disease affecting the crystalline lens of the eye, 
rendering it opaque. 

Symptoms. On looking into the eye, there will be seen, 
behind the pupil, an opaque body of a gray or dead-white 



SQUINTING. EARACHE. 273 

color. The patient usually gives, as its history, that his 
vision has become gradually impaired. 

Treatment. Apply to an oculist. Nothing but an oper- 
ation will restore sight. 



SQUINTING. (Strabismus.) 

Squinting consists either in an over-action or paralysis 
of some of the muscles of the eyeballs. 

Causes. Squinting is frequently congenital. Sometimes 
it is the result of imitation. It may be caused by some irri- 
tation of the stomach or bowels. Disturbance of the brain is 
another cause, especially when the squint does not come until 
adult age. 

Treatment. If caused by any intestinal irritation, it 
may be removed by purgatives, alteratives, or anthelmintics. 
In other cases it can only be cured by division of the proper 
muscle or muscles, for which apply to an oculist. 



EARACHE. (Otalgia.) 

This may be a symptom of inflammation of the ear, or of 
the presence of foreign bodies, or of inflammation of the ton- 
sils, or of derangement of the stomach, or of rheumatism 
affecting the head, &c. ; or it may be true neuralgia of the 
ear. When arising from neuralgia, the pain is most severe 
at the commencement, is unattended by fever, and often 
disappears suddenly. When arising from inflammation, it 
increases in severity, and is attended by fever. 

Treatment. If this trouble arises from foreign bodies 

in the ear, they should be removed. If from inflammation, 

treat the patient for that disease. When the affection is 

neuralgic, a mild cathartic and a blister behind the ear, 

18 



274 MEDICAL AND SURGICAL COMPANION. 

will do good. The following mixture often proves service- 
able : — 

Take of Glycerine, ... .2 drachms. 

Laudanum, .... 2 drachms. 

Mix. Drop a little into the ear ; also wet a little cotton 
wool with the same, and press -it into the ear, and let it 
remain for a few hours. If the patient has a carious tooth 
causing the trouble, it must be removed. 



INFLAMMATION OF THE EAR. (Otitis.) 

Inflammation of the ear may affect the external and in- 
ternal ear at the same time, or it may be confined to 
either. 

External otitis, or inflammation of the membrane lin- 
ing the external passage to the tympanum or drum of the 
ear, is at first characterized by dryness, itching, and heat of 
the part, gradually iucreasiug to a dull aching, and eventually 
to an acute pain, generally increased at night, causing great 
agony, sleeplessness, fever, and even delirium. The lining 
of the passage is swollen, dry, and pinkish ; in a short time 
a muco-purulent or purulent discharge takes place, and relief 
is then experienced. 

Internal otitis, or inflammation of the lining membrane 
of the cavity of the tympanum, is a most severe disease ; 
and is generally combined with inflammation of the mem- 
brana tympani. Though frequently a disease of youth, it 
may occur at any time of life ; cold is a frequent cause of 
it, especially in debilitated or scrofulous subjects. It com- 
mences with violent headache, followed by intense, acute, 
gradually increasing pain in the ear, and loud or beat- 
ing noises. After a short time, a sense of bursting or 
distention in the ear is experienced. The eyes become 



DISCHARGES FROM THE EAR. 275 

injected, the countenance anxious, the skin hot, pulse 
frequent, and the functions of the kidneys and bowels dis- 
ordered. Delirium is often present, or, in children, con- 
vulsions. Paralysis of the face may occur. The disease 
terminates in one of three ways : either by resolution ; or by 
suppuration, the pent-up pus bursting through the drum of 
the ear, and so discharging itself ; or by the inflammatory 
process spreading to other parts. 

Treatment. The treatment of both forms of inflamma- 
tion of the ear requires caution. The bowels should be kept 
open, perspiration promoted, and the patient should be kept 
quiet in bed. If there be much fever, R. 21 may be adminis- 
tered. Hot fomentations and poultices to the ear will be found 
soothing. When there is much suffering, Dover's powder or 
laudanum must be given in proper doses. Unfortunately 
the drum of the ear (tympanum) sometimes becomes rup- 
tured. Persons suffering from this disease should consult a 
physician as soon as possible. 



DISCHARGE FROM THE EAR. (Otorrhcea.) 

This is only a symptom of certain diseases of the ear, as 
of inflammation, polypus, granulations on the surface of 
the membrana tyrnpani, &c. It occurs very frequently, 
however, without any appreciable cause, in young children, 
about the time of teething ; or on the subsidence of measles 
or scarlet fever, especially in scrofulous subjects. Under 
appropriate treatment the discharge usually ceases in a short 
time ; but occasionally it becomes chronic, in which case it 
may cdntinue for years, leading, in the course of time, to 
disease of the surrounding parts. 

Treatment. Syringe the ear well with warm water, and 
then examine carefully the diseased surface. If the dis- 
charge be not severe, and no cause — as polypus, &c, — be 



276 MEDICAL AND SURGICAL COMPANION. 

found to account for it, a cure may often be effected by daily 
dropping into the ear a little of the following preparation : — 

Take of Sulphate of Zinc, . . .4 grains. 

Glycerine, . . . . 2 drachms. 

Rose water, . . . .14 drachms. 

Mix. 
When this fails, the surface of the canal should be painted 
with a solution of nitrate of silver (six grains to an ounce of 
water), by means of a camel's-hair brush. This must be re- 
peated every second day, the ear being frequently syringed, 
in the interval, w r ith warm water. The application of glyce- 
rine will also be beneficial after the syringing. Where the 
patient's general health is bad, tonics and change of air will 
be necessary. When occurring in scrofulous subjects, iodine, 
cod-liver oil, &c, may be taken with benefit. 



GONORRHOEA AND SYPHILIS. 277 



CHAPTER IV. 
THE VENEREAL DISEASES, &c. 

GONORRHOEA AND SYPHILIS. 

Gonorrhoea and syphilis were for a long period consid- 
ered identical ; but at the present day, the more enlightened 
members of the medical profession agree in the opinion that 
they are distinct diseases ; yet gonorrhoea is contracted 
under circumstances identical with those that give rise to 
syphilis. 

Gonorrhoea, Menorrhagia, clap, and urethritis, are terms 
used synonymously, and are employed somewhat indiscrimi- 
nately, to denote inflammation of the urethra and other por- 
tions of the genito-urinary passages, attended with contagious 
muco-purulent discharges, and scalding pain in micturition, 
consequent upon impure sexual intercourse. The discharge 
at first may consist almost entirely of mucus, but in a few 
hours it will be found to contain pus-globules, which in- 
crease in relative proportion, until the disease reaches its 
height. 

When the disease begins to decline, the morbid secretion 
is again changed, and is once more characterized by a pre- 
ponderance of mucus, until at last it becomes nearly trans- 
parent ; thus indicating that the pus-globules, upon which 
its contagious properties are supposed to depend, have 
ceased to be formed. 

Gonorrhoea is usually looked upon as a purely local dis- 
ease of the genital organs ; there are some surgeons, how- 
ever, who consider that it occasionally assumes a constitu- 



278 MEDICAL AND SURGICAL COMPANION. 

tional character. In the early stage it is probably a strictly 
local affection ; yet there is a particular train of phenomena 
occasionally following it, of a characteristic nature, which 
can scarcely be looked upon in any other light than as being 
the results of constitutional infection ; the more so, as they 
are very apt to occur in some individuals who never have 
gonorrhoea without the disease being followed by these 
sequences, whilst others are altogether exempt from them. 

The parts which are secondarily affected, are chiefly the 
fibrous tissues, the mucous and cutaneous surfaces. 

The affections of the fibrous tissue give rise to rheuma- 
tism (called gonorrhocal rheumatism), and the peculiar 
forms of inflammation of the testicle, and of the sclerotic 
coat of the eye. 

The affection of the mucous membrane shows itself in 
specific" inflammation of the throat and of the eyes. The 
skin may become the seat of certain eruptions. The occur- 
rence of these various affections, assuming a specific type, 
tends to show that the disease impresses the constitution in 
some peculiar manner, analogous to, though in a minor 
degree, and with less certainty than syphilis. 

Causes. True gonorrhoea is a specific and highly conta- 
gious affection, arising in all cases from the application to 
the parts which it attacks of a peculiar animal poison, gen- 
erated by impure or indiscriminate sexual intercourse. 

A spurious, or false gonorrhoea, ol' a. non-specific character, 
may arise from other causes. Sexual intercourse with a 
female during her menstrual period, or with one who is 
badly afflicted with leucorrhoea (whites), may cause a slight 
catarrhal discharge, possessing more or less acrid properties, 
but specifically different in its nature from the malignant or 
contagious gonorrhoea. 

Experiments and examinations have been made with a 
view to detect some characteristic differences between the 
true gonorrhoea! discharge, and some other discharges from 
the genital organs, but hitherto with no success. But a phy- 



GONORRHOEA AND SYPHILIS. 279 

sician, who understands well the nature of this disease, and 
who has had experience in such cases, can hardly fail to sat- 
isfy his own mind as to the true cause of any given case of 
gonorrhoea. 

Symptoms. The symptoms of gonorrhoea may be conven- 
iently divided into three stages. In the first stage, the pa- 
tient experiences a slight itching about the orifice of the 
urethra, accompanied, perhaps, with a slight watery, or thin 
whitish discharge. This stage usually comes on in from 
three to five days ; although it may occur in a few hours, or 
not until ten or twelve days after exposure. 

If the disease is not checked at once, it passes, after a few 
days, into the second, or acute inflammatory stage. The 
discharge now becomes abundant, thick, and of a greenish- 
yellow color ; there is great pain in urinating, with consid- 
erable heat and smarting ; the urine flows in a diminished 
stream, but is passed with increased frequency ; the urethra 
becomes swollen and cord-like to the touch ; the whole penis, 
in fact, becomes generally red and swollen. During this 
stage there is usually considerable constitutional disturbance, 
restlessness, and fever. It is in this stage that Chordee 
occurs, which is an intensely painful erection of the penis, 
during which it is bent like a bow, with the convexity up- 
wards. This stage usually continues a week or two, when 
the tliird stage, that of chronic inflammation, sets in. Dur- 
ing this stage of the affection the inflammatory symptoms 
gradually subside, but a thin muco-purulent discharge con- 
tinues, with some degree of heat and irritation about the 
urethra, and occasional smarting in passing water. Under 
proper treatment, this usually subsides in two or three weeks 
more, and the patient is cured. But if neglected, or improp- 
erly treated, or in certain constitutions, it may last many 
mouths or years, degenerating into a gleet, which in some 
cases is difficult to cure ; although I believe all, or nearly all 
cases, will yield to proper treatment and time. 

The inflammatory symptoms of gonorrhoea subside in pro- 



280 MEDICAL AND SURGICAL COMPANION. 

portion to the continuance of the affection, but its specific 
and contagious character may or may not exist so long as 
the discharge continues. This disease is most severe, con- 
tinues longer, and is more difficult of cure in first attacks, 
and in young and plethoric subjects. In scrofulous constitu- 
tions, and in constitutions where there is a rheumatic or 
gouty tendency, it often proves obstinate, requiring in both 
patient and physician much patience and perseverence in 
treatment. 

Treatment. In the majority of cases, in the male sub- 
ject, the anterior portion of the urethra is the primary seat 
of gonorrhoea. From this point the disease may extend, 
until the whole length of the canal is implicated, unless an 
effectual check be put to it by the abortive treatment. If 
the patient is seen during the first stage, before inflammatory 
symptoms have come on, that is, before the patient com- 
plains of scalding or burning pain in passing water, the fol- 
lowing injection, used every fourth hour, until the discharge 
is rendered thin and bloody, which is the ordinary effect of 
the injection, may lead to a speedy cure. 

Take of Crystals of Nitrate of Silver, . 2 grains. 

Distilled Water, ... .8 ounces. 
Mix. 

After discontinuing the nitrate of silver injection, one 
composed of eight grains of acetate of lead and four 
ounces of pure water, may be used night and morning for 
five or six days. 

The patient should take a Rochelle powder every morn- 
ing, and avoid exercise, liquors, salt, spice, coffee, and stim- 
ulants of every kind. 

By pursuing the course of treatment here laid down, at 
the very commencement of the disease, some cases, but not 
all, may be cut short, which would otherwise run the usual 
course. 

But, unfortunately, patients are seldom seen before the 



GONORRHOEA AND SYPHILIS. 281 

second or inflammatory stage is reached ; it is the burning 
pain in passing water, the profuse discharge from the ure- 
thra, and the inflammation and swelling of the penis, which 
causes the sufferer to seek the advice of a physician ; and 
then it is too late to make use of the measures just laid 
down for the first stage. 

If the disease has proceeded unchecked to the second 
stage, which is usually reached in one to three days, the 
patient should be confined to the house for a few days, if his 
avocations permit it ; but if they do not, he must avoid much 
walking, lifting, horseback-exercise, and everything which 
would excite the system. 

The penis and scrotum should be supported by a suspen- 
sory bandage, and be well fomented, night and morning, 
with water as warm as can be conveniently borne. The 
diet must be light and moderate ; meats, liquors, and stimu- 
lants of every kind being avoided. A cooling purgative, 
such as Epsom salts, or a Rochelle powder, may be taken 
every second day. Flaxseed tea, or gum arabic water, 
taken as a common drink, will prove serviceable. The fol- 
lowing mixture may also be used with benefit : — 

Take of Bicarbonate of Potassa, . . 6 drachms. 

Pure Water, . . . . 3J- ounces. 

Tincture of Opium, . . . £ ounce. 

Mucilage of Gum Arabic, . . 2 ounces. 

Syrup of Orange Peel, . . 2 ounces. 

Mix. One tablespoon ful may be taken in a little water, 
three or four times a day. After pursuing this course of 
treatment for a few days, the inflammation and fever will 
usually subside, and then P. 17, 18, or 19 may be taken 
for a week or ten days ; when, if the disease is obstinate, an 
injection (R. 95, 96, or 97) may be used for a few days. 

Ciioudee, or painful erection of the penis, with twist of 
the organ, coming on at night, is a distressing and trouble- 
some symptom, which will require attention in some cases of 



282 MEDICAL AND SURGICAL COMPANION. 

gonorrhoea ; and to prevent which, a pill composed of one 
grain of extract of opium and three of camphor, may be 
taken at bed-time. Lupulin, taken in drachm doses, on going 
to bed, will answer the same purpose. 

Cold water, freely applied to the part during the painful 
erection, will usually give immediate relief. 

BALANITIS. 

Balanitis is an inflammation of the surface of the glans 
penis, and inside of the prepuce, accompanied with a profuse 
purulent discharge, and more or less excoriation of the parts. 

Causes. The same that give rise to gonorrhoea. It may 
occur either with or without discharge from the urethra. 

A spurious balanitis may also occur in men with long 
prepuce, in consequence of the acrid secretions of the part 
being too long retained ; and it may occur in some persons 
from disordered health. 

Treatment. Soak the part well in warm water, night 
and morning, the prepuce being fully drawn back. The 
following wash may also be applied two or three times a 
day: — 

Take of Acetate of Lead, . . . .20 grains. 
Glycerine, . . . . .1 ounce. 

Eose Water, 7 ounces. 

Mix. 
If the trouble does not disappear in a few days, dissolve 
ten grains of the crystals of nitrate of silver in one ounce of 
water, and with a camel's-hair brush, apply it to the dis- 
eased surface once a day, for two or three days ; after 
which resume the use of the lead wash, and continue it 
until well. 

GONORRHEAL INFLAMMATION OF THE EYES. 

This is not a very common occurrence, but when it does 
happen, is of a dangerous character, running its course very 



GONORRHOEA IN THE FEMALE. 283 

rapidly, and unless treatment affords speedy relief, the con- 
sequences are liable to be disastrous to vision ; therefore, I 
would advise all who may be so unfortunate as to have this 
affection, to apply at once to some competent physician for 
treatment. 

GONORRHEAL RHEUMATISM. 

This usually occurs in young and florid persons. Some- 
times it attacks the muscular structures, and in other cases 
the joints are affected. It is in some cases an obstinate and 
painful affection. 

Treatment. The same as in common rheumatism. Ap- 
ply to a physician as soon as convenient. 

GLEET, OR CHRONIC GONORRHOEA. 

When from neglect, improper treatment, or constitutional 
causes, the third or declining stage of gonorrhoea is of long 
duration, a mucous or muco-purulent discharge from the 
urethra continuing, which resists treatment, a person is said 
to have a gleet. As this is often an obstinate affection, the 
sufferer should seek the aid of a reliable physician. Avoid 
quacks and the prescriptions of non-medical friends, for they 
may lead you into further trouble. 

GONORRHQ3A IN THE FEMALE. 

Under ordinary circumstances, this disease does not as- 
sume so severe a type in the female as in the male ; never- 
theless, it is, in all its essential features, nearly as difficult 
to manage in the one as in the other. The disease in the 
female is often confined to the vulva and vagina ; and, in 
such cases, the preparations of balsam of copaiba and cubebs, 
which are so useful when there is inflammation of the urethra, 
exert but little influence. If the patient is troubled with 
heat and scalding in passing water, such preparations will 
prove beneficial. During the acute stage, the patient should 
rest in the recumbent posture ; and the parts may be fre- 



284 MEDICAL AND SURGICAL COMPANION. 

quently washed and syringed with warm water. One drachm 
of acetate of lead, dissolved in one pint of water, forms a 
very good wash and injection, which may be used three times 
a day, immediately after the free use of warm water. 

A mild cathartic, as a Rochelle powder, or small dose of 
Epsom salts, may be taken two or three times a week, if 
necessary. A warm hip bath taken every night, on retiring, 
will also aid in reducing the inflammatory symptoms. The 
patient may make use of tire same diet and drinks as recom- 
mended for the male ; and if the disease affects the urethra, 
and there is much burning pain in passing water, the mix- 
tures recommended for the other sex will prove serviceable. 

After the acute symptoms have subsided, if the discharge 
from the vagina continues, R. 99 or 147 may be used as an 
injection two or three times a day. In very obstinate cases, 
R. 101 may be used once or twice a day for a few days. The 
injections should be taken when in the recumbent posture, 
and to do good, they must be retained ten to fifteen minutes. 
"When the disease begins to subside, treatment must be grad- 
ually discontinued. 

SYPHILIS. 

Syphilis, like gonorrhoea, is the effect of a certain morbid 
poison, generated, and in most cases communicated, by pro- 
miscuous sexual intercourse. 

It presents three classes of symptoms: — primary, secon- 
dary, and tertiary. The primary symptoms are ulceration of 
the parts to which the morbid poison is applied, and inflam- 
mation of the neighboring lymphatics, constituting bubo. 

To secondary symptoms are referred certain affections of 
the skin — syphilitic eruptions, and ulcerations, &c, about the 
throat and mouth, falling off of the hair, affections of the 
eyes, &c. Secondary symptoms usually manifest themselves 
about the sixth week after the primary symptoms ; some- 
times not for months or even years. Secondary symptoms 



ORIGIN AND HISTORY. 285 

are not inoculable, but may be transmitted by hereditary de- 
scent. 

The tertiary symptoms consist of certain changes which 
take place in the subcutaneous or submucous cellular tissue, 
in the testicles, in the fibrous and bony textures, and in the 
deep-seated organs, as the lungs, liver, heart, brain, kidneys, 
&c. These symptoms seldom occur before the sixth month 
following the appearance of the primary ulcer, and they may 
not for years. Tertiary symptoms are not only not inocu- 
lable, but cannot be transmitted by hereditary descent under 
their peculiar type, although in consequence of a kind of 
degeneration or modification of the syphilitic virus, they are 
probably one of the most fruitful sources of scrofula. 

ORIGIN AND HISTORY. 

"With regard to the origin of venereal diseases there is 
much uncertainty, and it is difficult to arrive at a satisfactory 
conclusion on the subject. But it is now believed by many 
enlightened medical men, that wherever prostitution is foul 
and unclean, restricted to few women amongst crowds of 
men, that there the infection will be generated, which after- 
wards spreads through society at large. 

With regard to the history of these diseases, I may say 
that most surgeons regard them as having been known from 
the earliest ages. Some passages in the Old Testament seem 
to point to these diseases ; and syphilis appears to have been 
known in China almost from time immemorial. 

"Whilst we have very good proof that syphilis did exist 
from the earliest ages, we have positive evidence that it re- 
ceived increased virulence between the years 1494 and 1496, 
whilst the French army, under Charles VIII., was besieging 
Naples. During that period this terrible disease sprung up 
and proved rebellious to every known method of treatment ; 
attacking the high and low, rich and poor ; sparing neither 
age nor sex. 

This increased virulence was probably the consequence of 



286 MEDICAL AND SURGICAL COMPANION. 

war, famine, and the intercourse of foreigners, — circum- 
stances which in all times have produced an aggravated type 
of the disease. 

PRIMARY SYPHILIS. 

Primary syphilis is characterized by ulcers or chancres ; 
their most frequent location being the genitals ; and in men 
they are more frequently than otherwise found on the inner 
surface of the prepuce, or the furrow between the prepuce and 
the corona glandis, or the angle by the frenuin ; and these 
parts should always .be carefully searched for ulcers. 
Chancres may be caused by the application of the syphilitic 
poison to any surface, mucous or cutaneons, entire, wounded, 
or ulcerated. 

The time at which venereal sores or chancres appear, is 
usually from the third to the tenth day after infection ; but it 
is probable that the syphilitic poison operates progressively 
from the first moment of its application, although no ulcer 
may be found for some days after exposure. 

The varieties presented by chancres may be described 
under the following denominations : — 

1. The simple chancre. 

2. The indurated or Hunterian chancre. 

3. The phagedenic chancre. 

4. The sloughing chancre. 

The simple chancre is the one most commonly met with, 
and consists of one or more small sores, of a shallow char- 
acter, resembling rather an abrasion with sharp cut edges, 
somewhat circular in shape, and having a tawny, grayish, or 
yellowish surface, with a narrow, red areola around the edge. 
In some cases chancres are attended with heat and itching. 
Their surface, in some instances, becomes covered with 
fungous granulations, of considerable size, from which they 
are termed f ungating sores. In other cases they are irritable, 
becoming very sensitive, with a tendency to spread, and hav- 
ing around them an areola of a dusky-red hue. It sometimes 



PBIMARY SYPHILIS. 287 

happens that these chancres are attended by much general 
inflammation and swelling of the penis. 

The indurated or Hunterian chancre, is much less frequently- 
met with than the variety just described. 

The general characteristic of this form of chancre is the 
hardness or induration of the edges and base ; and this 
character is met with from the very first. Any chancre, 
during its progress, may become hardened from undue inflam- 
mation, or from being otherwise improperly inflamed. 

The Hunterian chancre is usually found on the common 
integument, or on the glans penis. After the fifth or sixth 
day of its existence, if the cuticle, and dried pus which ad- 
heres to it, be removed, there is found an ulcer, resting on a 
hardened base ; its depth equal to the whole thickness of the 
true skin, its edges seeming as if cleanly cut out with a 
punch. The ulcer feels to the finger like a little cup of carti- 
lage or gristle set in flesh. . 

Phagedenic chancres are very rapid in their progress, and 
extremely painful. In shape they are irregular, with a 
yellow surface, dotted with red streaks ; the edges are ragged 
or undermined, and the discharge is copious, thin, and sanious. 
These ulcers sometimes eat deeply into the substance of the 
penis ; at other times they undermine the skin extensively ; 
but they generally spread widely, not deeply. 

The sloughing chancre is a combination of rapidly spread- 
ing and destructive gangrene with the syphilitic poison. It 
usually affects the prepuce and glans, giving rise to thick, 
black, soft, and pultaceous sloughs. 

Urethral chancre. A chancre may sometimes be found 
just within the orifice of the urethra, and may be seen on 
pressing open its lips, in the form of a small sloughy sore, 
which occasionally creeps out upon the glans. 

Syphilitic tdccrs in the female are usually situated just 
within the external organs of generation, very rarely on the 
lining membraue of the vagina, but sometimes on the neck of 
the uterus ; hence it is impossible to pronounce a woman free 



288 MEDICAL AND SURGICAL COMPANION. 

from syphilis, without examining these parts by means of a 
speculum. Chancres do not cause so much distress and an- 
noyance, at first, in the female as they do in the male ; but 
they are very slow in healing, especially when interfered with 
by the urine. 

AFFECTIONS THAT MAY BE MISTAKEN FOR SYPHILIS. 

External gonorrhoea, or balanitis, herpes of the prepuce, 
&c, may sometimes be mistaken for syphilis. 

The usual means of distinguishing a syphilitic ulcer are, 
that it is found on the genital organs ; that it has made its 
appearance subsequent to a suspicious connection ; that it is 
circular in form ; and, above all, that if treated by simple 
applications only, it is very difficult to heal. There is also 
the test of inoculation. 

TREATMENT OF PRIMARY SYPHILIS. 

In the treatment of primary syphilis, the indications are, 
1st, to destroy the poisonous ulcer, and heal the wound as 
soon as possible ; 2d, to prevent the occurrence of secondary 
symptoms. When the patient applies immediately on per- 
ceiving the chancre, it should be thoroughly destroyed by the 
cautious and proper use of nitric acid, or the potassa fusa. 
If this is done before the fifth day after inoculation, we may, 
possibly, prevent constitutional infection taking place from, 
the absorption of the poison into the system. But even 
though this time may have been considerably passed before 
the chancre is seen, it is well to destroy the ulcerating and 
poisonous surface, from which continual absorption must 
necessarily be going on. 

The acid may be applied to the sore by means of a glass 
rod, or piece of wood shaped like a pen-handle. Only 
enough of the acid to well wet the surface of the ulcer should 
be used ; and after it has been on a few seconds, a liberal 
supply of water must be poured upon the part, to wash away 
the superfluous acid. The potassa fusa is sometimes used, 



TREATMENT OF PRIMARY SYPHILIS. 289 

but is much, less managable, and not more efficacious than 
the acid. The nitrate of silver, — lunar caustic, — formerly- 
much used for destroying chancres, is too weak to secure the 
effect it is intended to accomplish ; being liable to irritate and 
inflame, and not to readily destroy the chancrous surface, 
thus necessitating repeated and painful applications. 

The acid may be applied at any time during the continu- 
ance of the specific condition of the ulcer ; but it should not 
be reapplied when once this has been destroyed. 

To promote the healing of the ulcer, after the application 
of the caustic, the following wash may be applied three or 
four times a day : 

Take of Solution of Subacetate of Lead, . 1 drachm. 

Glycerine, 3 drachms. 

Water, . . . . . 3 J- ounces. 
Mix. 

The " Black Wash" (R. 112) is also excellent. These are 
the means which generally prove most useful in the local 
treatment of simple and indurated chancres. 

Phagedenic chancres require different management ; the 
nitric acid cannot be borne if there is much irritability about 
the ulcer. A good application in such cases is the following 
opiate and antiseptic lotion : — 

Take of Tincture of Opium, . . . £ ounce. 

Solution of Chloride of Soda, . J- ounce. 

Water, 3 ounces. 

Mix. Apply three or four times a day. 

Sloughing chancres may be treated by the application, at 
first, of flaxseed or slippery-elm poultices, which may be made 
by wetting up the ingredient used with the above lotion. 
When the chancre begins to heal or granulate healthily, it 
may be dressed in the same way as a common ulcer. 

In applying lotions or washes to any form of chancre, a 
piece of lint soaked in the fluid should be kept constantly ap- 
19 



290 MEDICAL AND SURGICAL COMPANION. 

plied between the prepuce aud the glans, and in women, be- 
tween the labia ; for unless this be done, irritation aud 
morbid action will be kept up, by the coutact of the diseased 
and inflamed mucous surfaces. 

CONSTITUTIONAL TREATMENT OF PRIMARY SYPHILIS. 

As it is impossible to say when the absorption of the 
syphilitic poison into the system takes place, constitutional 
treatment should be resorted to from the very commence- 
ment of the disease ; not so much with a view of causiDg the 
local ulcer to heal, as to prevent, if possible, constitutional 
infection. The general treatment of primary syphilis has 
undergone many changes. At one time mercury was con- 
sidered a specific against the syphilitic poison ; and many 
celebrated surgeons looked upon the curability of a sore with- 
out mercury as a proof that it was not syphilitic. At a later 
period, however, it was found, by the observations of some 
army surgeons, that the different forms of primary syphilis 
were curable without the necessity of administering mercury, 
or having recourse to any specific treatment whatever. 
These observations led to the introduction of the non-mercu- 
rial or simple plan of treatment, as it is termed ; a mode of 
practice that at one time was regarded with great favor, and 
which has been extensively tried. But further observations 
and experiments have caused a reaction to take place in the 
minds of most professional men, and mercury is again em- 
ployed in the treatment of this disease, but more moderately 
and scientifically, and consequently more successfully, than 
before. 

Formerly, the administration to salivation was deemed the 
specific for syphilis ; and it was not only believed that it had 
peculiar virtues in counteracting the syphilitic poison, but 
also that without it every case of syphilis would infallibly go 
on from bad to worse. The doctrine at the present day, 
however, is, that every case of syphilis may be successfully 
treated without mercury ; and that the too free use of it may 



CONSTITUTIONAL TREATMENT OF PRIMARY SYPHILIS. 291 

render the disease much worse ; that there are some cases 
which do not admit of its use ; but that in proper cases, its 
moderate and judicious employment more effectually hastens 
the removal of the existing symptoms, and renders the 
patient much less liable to have secondary affections than any 
other course of treatment which has hitherto been pursued. 

Mercury is not generally admissible when the chancre is 
inflamed, irritable, phagedenic, or sloughing ; when there is 
a bubo, suppurating, or about to suppurate ; when the pa- 
tient is feverish ; when he has been already broken down by 
repeated attacks of the disease and by mercury ; when he is 
known to be very easily salivated ; or when mercury readily 
produces sore thi*oat, loss of flesh, night sweats, &c. It 
should be given with much caution to scrofulous or consump- 
tive persons. 

If there are none of these contra-indications, and especially 
if we have an indurated or hard chancre to deal with, mer- 
cury may be given ; not because absolutely necessary to a 
cure, but because, as before remarked, experience has proved 
that no other remedy so effectually hastens the cure of the 
primary, and lessens the chance of secondary symptoms. 

In administering this medicine, our object should be to 
induce a gentle mercurial action, and to maintain it for a suf- 
ficient length of time. The following preparation will be 
found very efficacious : — 

Take of Bichloride of Mercury, . . 2 grains. 

Iodide of Potassium, . . £ drachm. 

Pure Water, . . .3 ounces. 

Syrup of Orange Peel, . . 1 ounce. 

Mix. One teaspoonful may be taken in a gill of water, 
three times a day, after meals. Recipe 69 will also be found 
excellent. It makes little difference which is used. 

The medicine should be taken only to the extent of pro- 
ducing slight sponginess and soreness of the gums, when it 
may be omitted for a day or two, or only one dose a day 



292 MEDICAL AND SURGICAL COMPANION. 

given ; so regulating the quantity taken as to maintain a 
gentle action upon the system, till — if the case progresses 
favorably — the ulcer has healed, and the hardness of the 
sore disappeared ; which will generally take place in from 
two to eight weeks. 

After the mercurial course has been continued for a suffi- 
cient length of time, R. 67 may be taken for three or four 
weeks. 

If we have phagedenic or sloughing chancre to deal with, 
R. 67 may be used instead of mercury, from the very com- 
mencement of the treatment. In cases where there is much 
debility, R. 62 or 63 will often be found beneficial. 



BUBO. 

A bubo is an inflamed lymphatic vessel or gland in the 
groin, leading from a venereal sore. Gonorrhoea, wounds 
about the feet, or even protracted venereal indulgence may 
cause inflammation of the glands ; but a real syphilitic bubo 
is the result of absorbed virus. Buboes vary in the rapidity 
of their development, consequently some are termed acute, 
others chronic ; the former hastening to suppuration, whilst 
the latter are indolent. 

Buboes sometimes arise in cases where no chancre has 
been observed ; and it has been disputed whether the syphi- 
litic virus may be taken up by the lymphatics, and produce a 
bubo in the groin, without having first caused a chancre. 
When cases of this kind arise, we must bear in mind that 
they may be produced by a chancre so small as to have es- 
caped the patient's notice ; and that inflammation of the 
glands in the groin may arise from other causes than the 
absorption of the syphilitic virus. 

Treatment. An acute bubo must be treated as an acute 
abscess ; and the first indication is to produce resolution. 
This may in some cases be brought about by rest, cathartics, 



VENEREAL WARTS. 293 

low diet, leeches, the iodine paint, fomentations, &c. ; but if 
the venereal virus shall have created pus in the interior, 
leeches, iodine paint, &c, will rather retard the cure. 
Poultices, and the early evacuation of the pus, are then most to 
be relied on. Blisters, or the iodine paint externally, with 
iodide of potassium (R. 67) internally, will be found of use in 
producing the absorption of chronic bubo. 

After a bubo has been opened, the cavity exposed may 
present a chancrous appearance, and require the same treat- 
ment as a chancre on the penis. In all such cases the pa- 
tient should, if possible, be under the care of a competent 
physician ; for in some instances sloughing action is set up 
in the open bubo, and then great destruction of tissue may 
ensue, and even fatal hemorrhage from the femoral artery 
has been known to occur. 



VENEREAL WARTS. 

Venereal warts generally appear on the prepuce or glans, 
and are very apt to be situated in the angle between these 
parts. They are very vascular, and of a reddish color ; and, 
if not interfered with, may increase immensely in size and 
number. They are occasionally met with in the vagina, 
forming large, irregular, cauliflower-looking masses. 

These warts may occur as the result of gonorrhoea, or 
primary syphilis, independently of any constitutional affec- 
tion, arising from simple irritation of the muco-cutaneous 
surfaces ; but there are also warts, or verruca?, of a truly 
specific and contagious character. 

Treatment. This consists in removing them with a knife, 
scissors, or ligature, and afterwards touching the part from 
which they spring with caustic, in order to prevent their re- 
currence. They may be removed by other and milder 
measures, when the above are not practicable ; as the re- 
peated application - of nitrate of silver, caustic powders, 
astringent washes, &c. 



294 MEDICAL AND SURGICAL COMPANION. 



SECONDARY SYPHILIS. 

The symptoms of secondary syphilis frequently manifest 
themselves about the sixth week after the appearance of the 
primary disease ; sometimes they do not appear for months, 
or even years. Before their appearance the patient fre- 
quently becomes thin, and somewhat debilitated ; the appe- 
tite fails, and he may be much afflicted with rheumatic paius. 
The symptoms generally manifest themselves upon the skin, 
in the form of eruptions ; then upon the mucous membrane 
of the throat, and finally the bones become affected, if the 
disease is allowed to go on unchecked. 

Syphilitic eruptions may take the form of lichen, psoriasis, 
lepra, rupia, or ecthyma. They are generally copper-colored. 
[See article on Diseases of the Skin.] 

SYPHILITIC SORE THROAT. 

In some mild cases of syphilitic sore throat, there is merely 
a superficial excoriation of the mucous membrane of the ton- 
sils, or some other part of the mouth or fauces, the parts 
affected being swollen and sore, presenting, generally, a red 
and glazed appearance, the natural epithelium of the parts 
being absent. This state may exist in a mere patch, or it 
may extend nearly over the whole tongue and inside of the 
lips. In other cases, we find upon the tonsil an excavated 
ulcer, looking as if a piece had been scooped out of the part ; 
its surface having a foul, yellow look, with raised edges, 
which are ragged and swollen. The inconvenience and con- 
stitutional affection from it may be little, unless it be attended 
with an eruption. The patient will often complain of pain 
in his ears, and will have a peculiar guttural way of speak- 
ing. A sloughing ulcer is more serious. It usually begins 
as a small aphthous spot, which rapidly ulcerates, and is at- 
tended with considerable pain and fever. Upon the surface 
of the ulcer there is an ash-colored slough, the surrouudiug 
mucous membrane bein°; dark, livid, and swollen. 



TREATMENT OF SECONDARY SYPHILIS. 295 

TERTIARY SYPHILIS. 

"When the bones, deep-seated tissues, and internal organs 
become affected, a patient is said to be laboring under the 
tertiary form of syphilis. 

SYPHILITIC DISEASE OF BONE. 

When the syphilitic disease affects the osseous system, it 
most frequently attacks the superficial bones, as the tibia, 
(shin bone), collar bone, bones of the skull, &c, commencing 
with tenderness of the affected bone, and severe pain during 
the night, the pain being soon accompanied with oblong 
swellings, called nodes, which arise from infiltration of the 
periosteum, or membrane covering the bone, with lymph 
and serum. If the disease is arrested at this stage, it causes 
only a superficial deposit of rough, porous bone, from the 
organization of the effused lymph. If the disease proceeds 
further, a quantity of glairy serum becomes effused between 
the periosteum and bone, producing a painful fluctuating 
tumor. If the disease be allowed to proceed still further, 
the bone soon becomes carious. In some cases extensive 
exfoliations of bone ensue, and the patient may suffer severely 
from the pain and discharge. 

TREATMENT OF SECONDARY SYPHILIS. 

If we have a venereal eruption and sore throat to deal 
with, and the patient has never taken a course of mercury, 
or but an imperfect one, and his constitution is sound, that 
remedy may be given as directed in the foregoing pages for 
primary syphilis. If, while under its use, the patient be- 
comes thinner and weaker, and suffers from chills or fever- 
ishness, or if the ulcers become phagedenic and irritable, the 
mercury should be discontinued, and the iodide of potassium 
(R. G7) given instead. 

In cases where the constitution is considerably broken 
down, the preparatious of iron (R. 59, G2), or iron and 
quinine (R. 68), with good living, wholesome air, and every- 



296 MEDICAL AND SURGICAL COMPANION. 

thing which will tend to improve the general health, must 
be resorted to. In the treatment of tertiary syphilis, 
mercury should not be given, otherwise the treatment may 
be the same as for secondary. 

Local Treatment. Ulcers in the throat require the ap- 
plication of nitrate of silver, or tincture of iodiue, once in two 
to four days' for two or three weeks. At the same time, the 
following gargle may be used, three to five times a day : — 

Take of Chlorate of Potassa, . . 6 drachms. 

Hydrochloric Acid, . . £ drachm. 

Pure Water, . . .1 pint. 

Mix. 

For syphilitic eruptions, the warm and sulphur baths will 
often prove beneficial. Various washes and ointments prove 
serviceable, but instead of mentioning them here, I will refer 
the reader to the article on Diseases of the Skin. 

SYPHILITIC DISEASE IN CHILDREN. 

It is probable that a man laboring under constitutional 
syphilis may communicate it to his wife ; and if she become 
pregnant by him, it may be communicated to her through 
the medium of the foetus ; but, at all events, if the wife has 
it, she may communicate it to the foetus in utero. In some 
of these cases the foetus may die about the third or fourth 
month, and the woman repeatedly miscarry. In some cases 
the child is born sickly, and copper-colored blotches or ulcers 
may be found about the anus or vulva, and aphtha? in the 
mouth. Sometimes the child is born apparently healthy, 
these symptoms appearing some weeks afterwards. Then a 
child may contract primary syphilis from the mother during 
its birth. In all these cases the parents should be properly 
treated for syphilis. 

Treatment of the Infant. The child should be brought 
up by hand, lest it infect the nurse, or continue to receive 
fresh accessions of poison from the diseased milk of the 



STRICTURE OF THE URETHRA. 297 

mother. The medical treatment may consist in rubbing 
eight to twelve grains of mercurial ointment into the arm- 
pits, or groins, every day, until the symptoms disappear. In 
these cases the symptoms are apt to recur once or twice, but 
by perseverance, a favorable result may be hoped for. After 
the mercurial ointment has been used for two to four weeks, 
minute doses, — from the twelfth to the fourth of a grain, — 
of iodide of potassium, may be given in milk, or cod-liver 
oil. This may be continued for two or three weeks. 

It will be well to remember that syphilis is a very serious 
disease ; one which tends to break down the system, and 
which may be transmitted to future generations ; therefore, 
let all afflicted by this malady, place themselves under the 
treatment of some regular and reliable physician, until the 
disease is eradicated, and health restored. Remember that 
it requires a long time to thoroughly remove such a poison 
from the system, and be patient and persevering. 



OTHER DISEASES OF THE URINO-GENITAL 
ORGANS. 

STRICTURE OF THE URETHRA. 

Spasmodic Stricture. This depends on spasm of the 
muscles of the perineum, or upon contraction of the muscu- 
lar portion of the urethra. It generally occurs in persons 
with some permanent obstruction. It may be caused by 
exposure to cold or indulgence in drink. 

Symptoms. Sudden retention of urine ; great straining 
and desire to pass water ; the bladder becomes distended, 
the countenance anxious, the pulse quick, the skiu hot ; at 
last the urine dribbles, or the bladder may burst. 

Inflammatory stricture is another variety of the above, gen- 
erally caused by abuse of injections, exposure, or intempe- 
rance, during the acute stage of gonorrhoea. 

Treatmekt. A catheter should be introduced at once. 



Zy» MEDICAL AND SURGICAL COMPANION". 

This is managed by introducing as large an instrument a9 
the parts will admit of, and stretching the penis forward on 
the instrument, the point of which should be directed to- 
wards the upper surface of the passage, and pressed steadily 
but gently against any obstruction. Relaxation of the 
spasm may also frequently be produced by a copious warm- 
water injection into the bowel, warm hip bath, ten grains 
of Dover's powder, and cold water upon the genitals. 
Should these means fail, call a surgeon as soon as possible. 

Permanent Stricture. This is a contraction, or grow- 
ing up of the passage, from chronic inflammation. 

Causes. Gonorrhoea (clap), kicks, blows, or other injury 
to the part ; riding on horseback, excessive use of spiritous 
liquors, &c. 

Symptoms. The patient at first finds that he wants to 
make water oftener than usual, and that he has more or less 
uneasy sensation in the perineum after doing so ; he also 
notices that a few drops hang in the passage, and dribble 
from him after he has buttoned up. Soon he notices that 
the stream of water is smaller than usual, and forked, or 
scattered, or twisted, and that he requires a longer time and 
greater effort than usual to pass it. If the disease is al- 
lowed to proceed, the bladder becomes irritable, obliging the 
patient to rise in the night to void urine. He is liable to 
attacks of a spasmodic or inflammatory character, with com- 
plete retention, as previously described. 

Treatment. Apply to a surgeon as soon as possible. 
If you tamper with it yourself, serious results may follow. 
The stricture may be situated within two or three inches of 
the end of the penis, or far back towards the bladder. Sur- 
geons can frequently dilate the stricture by bougies, or other 
instruments. 



INFLAMED TESTICLE. 299 



SWELLED OR INFLAMED TESTICLE. (Orchitis.) 

Causes. It is often the result of injury, but oftener of 
gonorrhoea and its treatment ; excessive exercise, wet, and 
cold may induce it. It is a not uncommon accompaniment 
of mumps. 

Symptoms. There is a sense of great weight, and the 
swelling constantly increases ; the skin becomes tense, red, 
and glistening ; the pain is often intense, sometimes produ- 
cing fever and vomiting. If it occurs in a case of gonorrhoea, 
the urethral discharge diminishes or ceases for a time. 

Treatment. Low diet and the recumbent position are 
essential. A dose of Epsom salts should be taken as a pur- 
gative, and after the bowels have been thoroughly moved, 
proper doses of laudanum or morphine may be taken every 
three or four hours, to relieve the pain. Four or six leeches, 
applied to the part, often do good. Warm or cold water, 
according to the feelings of the patient, freely applied to 
the part, will prove serviceable. The weight of the part 
must be sustained, while lying down, by a pillow, or some- 
thing of the kind placed between the thighs. When able 
to rise and walk about, a suspensory bandage should be 
worn for a time. 

After the acute symptoms have subsided, friction with 
mercurial ointment, astringent lotions, and compression by 
adhesive straps, will be beneficial. In discussing the hard- 
ness and swelling which generally remain, the iodide of 
potassium has the best effect. 

Take of Iodide of Potassium, . . .8 scruples. 
Spearmint Water, . . .4 ounces. 

Mix. A teaspoonful may be taken in a wineglass of 
water, three times a day, for several weeks. 



300 MEDICAL AND SURGICAL COMP ANION. 



DROPSY OF THE SCROTUM. {Hydrocele.) 

Hydrocele, or dropsy of the scrotum, is a collection of 
fluid in the tunica vaginalis testis, commencing at the lower 
part of the scrotum oi* bag, and gradually ascending. It 
is smooth on its surface, fluctuating. The testicle is situ- 
ated at the back part of the sac, near the middle. It may 
be distinguished from hernia or rupture, by its transpa- 
rency and progress ; there is no impulse upon coughing ; 
it does not retire when the patient lies down. 

Treatment. The jjalliaiive treatment consists in evacu- 
ating the fluid by puncturing the sac with a trocar. The 
radical cure is performed by first drawing off the liquid, 
and then ejecting stimulating fluids, such as port wine and 
water, tincture of iodine, &c. Always consult a surgeon 
for this affection. 



VARICOCELE. 

Varicocele is an enlarged condition of the veins of the 
spermatic cord. The left side is more frequently affected 
than the right. The swelling is pear-shaped, and feels 
through the scrotum like a bunch of earth-worms. 

Causes. The causes are such as produce obstruction to 
the return of blood ; constipation, corpulence, tight belts 
around the body, &c. 

Treatment. The disease may be palliated or relieved 
by removing the causes, bathing the testicle in cold water 
frequently, and supporting it with a suspensory bandage. 
The radical cure often requires an operation for the oblit- 
eration of the veins ; but this should not be resorted to 
unless the patient suffers great inconvenience from the en- 
largement, &c. Always take a surgeon's advice in this 
disease. 



SPERMATORRHEA. 301 



SPERMATORRHEA. 

The chief feature of this disease is the involuntary escape 
of seminal fluid, which, if often repeated, and for a long 
time, proves most injurious to the mental and bodily health. 
The iuvoluntary discharges usually take place during the 
night, and iu the hours of sleep ; but in some instances they 
occur in the daytime, and the fluid may pass off with the 
urine. 

The most frequent cause of this disease is masturbation, or 
self-abuse. The consequences of this affection are general 
weakness, with nervous irritability. There is mental de- 
pression ; a desire for a dreamy kind of existence, rather 
than a wish to follow any active occupation ; the digestive 
organs frequently get disordered, as is indicated by flatu- 
lence and constipation ; the sense of hearing, as well as of 
sight, becomes impaired ; there is loss of memory, and an 
inability to fix the attention : while attacks of palpitation, 
giddiness, shortness of breath, headache, and neuralgia are 
far from uncommon. In extreme instances, it is believed 
the final result may be epilepsy, consumption, insanity, or 
impotence. Excessive sexual intercourse may lead to simi- 
lar results. 

It is to be feared that many young persons, of both sexes, 
impair their health by masturbation, or self-abuse. Parents 
and guardians should regard it a duty to instil correct ideas, 
in regard to this subject, into the minds of those under their 
care. 

Treatment. All bad habits which have tended to bring 
on the trouble must be abandoned ; and the patient should 
read no books on the subject of his disorder. He should 
work steadily at his occupation, seek cheerful society in the 
evening, take a proper amount of exercise, sleep upon a 
mattress, not remain in bed more than eight hours, not 
indulge in heavy meals, and avoid smoking and the use of 



302 MEDICAL AND SURGICAL COMPANION. 

alcoholic drinks. Tonics (R. 59, 62, 63) are often required, 
and a proper sedative, as a drachm of lupulin, may be taken 
on retiring. If the patient is of proper age, marriage may 
prove beneficial. 

An occasional involuntary seminal emission, occurring in 
a healthy individual, of correct habits, need excite no uneasi- 
ness. Such cases are not uncommon nor unnatural, and 
they need no treatment. 

All young persons who have abused themselves, and 
thereby injured their health, will do well to take the advice 
of some reliable physician. 



IMPOTENCY. 

Impotence means inability to perform the act of coition. 
There are three varieties. The first arises from an original 
defect in the organs of generation. The second, from local 
debility of the parts, brought on by masturbation, — self- 
abuse, — excessive sexual intercourse, or some prostrating 
sickness. The third originates from fear, excess of passion, 
or want of confidence at the moment of coition. 

The first is incurable. The second must be treated by 
the general principles and remedies which tend to restore the 
strength of the system ; consisting of the cold bath, tonics 
(R. 59, 63), generous diet, exercise, and by steadily avoiding 
the causes which may have produced it. If the general health 
is much impaired, consult some reliable physician. The rem- 
edies for the third, must be sought for in calming excessive 
agitation, and acquiring, by habits of intimacy, that confi- 
dence they are sure to produce. 



DISEASES OF THE PROSTATE GLAND. 

The prostate gland is a muscular body, consisting of circu- 
lar involuntary fibres, with one large central hole for the 



PROSTATORKHCEA. 303 

passage of the urethra, and another smaller oblique opening, 
directed upwards, below the former, for the transmission of 
the common ejaculatorj seminal ducts to the central urinary 
canal. Its circular fibres are directly continuous behind, 
without any separation, with the circular fibres of the blad- 
der. The prostate is thus essentially a circular, involuntary 
sphincter to the neck of the bladder, and expeller of the 
semen. It secretes a fluid termed the liquor prostatitis. 

PROSTATORRHCEA. 

Prostatorrhoea signifies a discharge from the prostate gland. 
Owing to irritation or congestion of the prostate, the liquor 
prostatitis, or prostatic fluid, is frequently secreted in excess, 
and, in some cases, to such an extent that the urethra is kept 
constantly wet with the fluid, which is slimy, resembling 
diluted white of egg. In some cases, at times, the secretion 
may have a milky appearance, and there may be some heat 
and scalding of the urine. In other cases, the secretion is 
only noticed after going to stool ; it then escapes with the last 
drops of urine, being pressed out by the straining efforts in 
defecation. This secretion is often mistaken for semen ; and 
it is only by a microscopic examination of the fluid that the 
question can be settled. In many of these cases the urethra 
is found over-sensitive, the passing of a sound or bougie 
causing acute pain, which will be most severe when the 
instrument is passing through the prostatic portion of the 
canal. In these cases, during an erection, or as it subsides, 
which is apt to be very quickly, a glairy or slimy fluid 
issues from the urethra. If this state of things long exists, 
the organs become more or less weakened. 

Causes. Masturbation (self-abuse), excessive sexual in- 
tercourse, excessive spirit-drinking, the irritation of gravel, 
&c. 

Treatment. This is a curable complaint, but sometimes 
it proves obstinate. Undoubtedly many cases are treated, 
by quacks, as spermatorrhoea. The organs require rest for 



304 MEDICAL AND SURGICAL COMPANION. 

a considerable time ; and any bad habits which have tended 
to produce the complaint, must be entirely abandoned. If 
the urine is too strongly acid, the proper use of alkalies will 
be beneficial. The passing into the bladder of a No. 10 steel 
sound, every fourth day, and allowing it to remain ten or 
fifteen minutes, often proves serviceable. If the patient is 
debilitated, tonics will be required ; if plethoric, sedatives 
will be useful. As this is a very annoying trouble, the 
wisest course for a patient to pursue is to place himself 
under the care of some regular and reliable physician ; he 
should let him have charge of the case, while he withdraws 
his mind from it as much as possible. A patient is some- 
times afflicted with both spermatorrhoea and prostatorrhcea, 
but with proper treatment he will recover from them. 

INFLAMMATION OF THE PROSTATE GLAND. 

Acute inflammation of the prostate gland is generally a 
consequence of acute gonorrhoea, but may be caused by 
stricture, stone, or any other source of irritation. 

Symptoms. Great weight, pain, and throbbing at the 
neck of the bladder ; violent, and exceedingly painful efforts 
to make water. As the inflammation subsides, a grayish, 
viscid, muco-purulent matter is voided with the urine. 

Treatment. Rest in bed, low diet, hot hip baths, leeches 
to the perineum ; and half a teaspoonful of laudanum in a 
wineglass of thin warm starch, may be injected into the 
bowel at night, to relieve pain and promote sleep. It may 
also be used during the day, if the pain is excessive. 

The inflammation sometimes becomes chronic, and then 
should be treated by baths, iodide of potassium, &c. 

An abscess may occur in the prostate, in scrofulous sub- 
jects. 

Chronic enlargement of the prostate gland is an affec- 
tion peculiar to advanced life, and consists of an increase 
of the natural muscular structure, and incidentally of the 
glandular. 



GRAVEL AND STONE. 305 

Symptoms. The symptoms which the patient describes, 
are slowness and difficulty in making water, sense of weight 
in the perineum, and a frequent desire to evacuate the 
bowels, with pain in so doing, so that he often ascribes his 
trouble to internal piles. In the next place, the bladder 
becomes irritable, and calls to make water are oftener than 
usual. Then, as the patient cannot empty the organ com- 
pletely, in consequence of a projection formed by the tumor, 
a portion of urine always remains behind, and decomposes, 
and becomes ammoniacal. Sometimes a fit of complete 
retention ensues ; and it may be brought on by exposure to 
cold, or excessive sexual indulgence. 

Treatment. This must be palliative. If complete re- 
tention occurs, the catheter should be passed, if possible, and 
the urine drawn off". But this cannot often be done by any 
one excpt a physician who thoroughly understands the 
nature of the obstruction, and how to surmount it. The 
warm hip bath, and laudanum and starch injections, often 
prove serviceable. 

In all cases of retention of urine, from whatever cause, if 
the patient does not soon obtain relief, send for a surgeon. 
Delay in such cases is dangerous. 

GRAVEL AND STONE. ( Urinary Calculus.) 

Gravel is usually formed in the kidneys, by a precipita- 
tion of earthy substance. It often passes off freely and 
frequently. When retained until a large mass is formed, 
the disease is called stone. 

Symptoms. Pain in the loins, irritation and retraction of 
the testicle, bloody urine and inflammation of the kidney. 
The passage of the stone through the ureter (a tube convey- 
ing the urine from the kidney to the bladder) causes most 
acute and severe pain in the loins and groin, faintness and 
nausea, which may last for several days, and is only relieved 
by the stone entering the bladder. 
20 



306 MEDICAL AND SURGICAL COMPANION. 

Treatment. The treatment for a fit of the gravel, as 
these attacks are called, consists in large doses of opium, 
warm bath, flaxseed or slippery-elm tea, and castor oil to 
move the bowels. When the pain is very severe, forty drops 
of laudanum may be given, and repeated in an hour, if 
necessary. Flannel wrung out of hot water, and laid over 
the seat of pain, will prove beneficial, and should be used 
in cases where there are no facilities for a warm bath. It 
must be applied as hot as can be conveniently borne, and 
changed often. A warm-water injection will prove servicea- 
ble. In some of these cases the pain is so intense that It 
may be advisable to etherize the patient ; but this should 
never be attempted except by some person who knows how 
to do it properly. 

STONE IN THE BLADDER. 

Symptoms. The symptoms of stone in the bladder are 
frequent, sudden, irresistible, unrelieved desire to make 
water ; pain in the glans penis, and elongation of the pre- 
puce ; sudden stopping of the stream in passing water, and 
its reestablishment by change of position — the urine being 
mixed with mucus, and sometimes with blood. 

"Whenever a person suspects he has a stone in his bladder, 
he should apply at once to a physician, who will decide the 
question by an examination with an instrument called a 
sound. Stones vary in their form, size, color, consistence, 
and chemical composition ; some are rough on their surface, 
others smooth ; they are more frequently of an oval shape. 
The size may be that of a pea, or that of a goose-egg. 
Some are soft and friable, and crumble easily ; others are 
flinty, and require great force to break them. The most 
common color is a light brown ; some, however, are nearly 
white, others nearly black. 

Causes. Derangement of health ; deficiency. of exercise ; 
indulgence in animal food ; and dyspepsia. It is also depen- 
dent upon climate, age, locality, and hereditary influences. 



LITHOTKITT. LITHOTOMY. 307 

The character of the water drank undoubtedly influences its 
production. 

Treatment. When a stone of considerable size has 
formed in the bladder, it cannot be removed by medicines ; 
surgical means must be resorted to. 

LITHOTRITY. 

This implies the crushing of the stone whilst in the blad- 
der, by an instrument constructed for that purpose. After 
this is done, the fragments gradually escape with the urine. 

LITHOTOMY. 

This implies cutting for the stone, and is resorted to when, 
from any cause, lithotrity cannot be made available. In 
this operation, an opening is made into the bladder, at a 
proper point, and the stone at once removed. None but an 
experienced surgeon should undertake such an operation. 

When a person is troubled with gravel, and before a stone 
has formed in the bladder, medicines may prove beneficial. 
The general health should be improved, and if the water 
drank come from a chalk or limestone district, it must be 
avoided. 

When the gravel is of an acid character, the alkalies, soda 
and potash, taken for a considerable time, may prove bene- 
ficial. If of an alkaline nature, the mineral acids may be 
resorted to with benefit. Never tamper with yourself in 
this disease, for no one but a physician can decide upon the 
proper remedy for you. 

PHYMOSIS AND PARAPHIMOSIS. 

Piiymosis is said to exist when the prepuce or foreskin cannot be drawn 
back over the glans penis. For treatment, apply to a surgeon. 

PARAPHTMOSI8 is the opposite condition to that just described; the prepuce 
is retracted, and cannot be brought forward. Swelling of the glans takes 
place, and will, if rcljef be not obtained, terminate in mortification. For treat- 
ment, apply to a surgeon at once. By applying cold water to the part for an 
hour or two, and then endeavoring to draw the foreskin forward with one 
hand, while you try to compress and push the glans back with the other, relief 
may be obtuincd. 



308 MEDICAL AND SURGICAL COMPANION. 



CHAPTER V. 

ON ABSCESS AND ULCERS. 

ABSCESS. 

A collection of pus or matter in any part of the body is 
termed an abscess. Every swelling or tumor which ends in 
the formation of matter is properly an abscess. 

Symptoms. When pus begins to form during an acute 
inflammation, the event is generally indicated by chills, 
cessation of the pain, flushes of heat, and decline of the fever. 
If the abscess is upon the surface of the body, there will 
usually be a white spot on the inflamed part, more prominent 
thau the rest of the tumor, softer, and disposed to fluctuate 
when pressed with the fingers. 

Treatment. The proper treatment of an abscess consists 
in the application of warm poultices and fomentations, in 
order to hasten the formation of matter. Poultices of bread 
and milk, flaxseed meal, or ground slippery-elm bark may 
be used. When pus can be detected by the softness and 
fluctuation of the part, open it with a lancet. After the 
matter is discharged, the application of poultices should 
be continued as long as there are any signs of active in- 
flammation, or redness, pain, and soreness. The cavity 
must be kept clean, and the diet should be plentiful and 
nutritious. If an abscess is large, and the patient of feeble 
constitution, tonics, such as the preparations of iron or quinine, 
may be necessary. 



WHERE TO OPEN AN ABSCESS. 309 

After the inflammation has subsided, the abscess may be 
dressed with simple cerate, as a common sore. 

If the cavity of an abscess is large, and the healing pro- 
cess very slow, dissolve twenty grains of s*ulphate of zinc in 
a pint of water, and use the solution as a wash once or twice 
a day, for several days. A wash made by adding one ounce 
of solution of chloride of soda to eight of water often proves 
beneficial. 

WHERE TO OPEN AN ABSCESS, ETC. 

When only a small puncture is needed, a common lancet 
answers very well. When a larger opening is necessary, a 
proper abscess lancet may be employed. By moving one of 
these instruments forward, after the part has been punctured, 
the opening may be made of any required size. Great 
caution should be observed in opening abscesses situated 
near important organs, or in the palm of the hand, or on the 
foot, or the inner side of the extremities, for fear of injury to 
the organs, or of wounding arteries. Be sure that you do 
not put your lancet into a sack of blood instead of an ab- 
scess* 

When sure you are dealing with an abscess, and the time 
has arrived for opening it, the best place to puncture is gener- 
ally where the fluctuation is most perceptible, or where the 
pointing takes place ; for here the skin is thinnest. This 
consideration, however, is not to make us unmindful of the 
advantages of a depending opening, which lets the matter 
readily escape, and often removes all occasion, either for the 
enlargement of the first opening or for the formation of a 
second in another place. The latter, which is termed a 
counter-opening, becomes necessary when an abscess bursts 
at a point from which the matter cannot escape with sufficient 
readiness. The size of the opening should be such as will 
allow the matter to escape with facility 



310 MEDICAL AND SURGICAL COMPANION. 



ULCERS. 

By ulcers, are meant holes or sores in the skin and flesh, 
which discharge matter or pus. They may be divided into 
healthy, inflamed, fungous, sloughiug, indolent, varicose, and 
carious. 

HEALTHY ULCER. 

Symptoms. A healthy or healing ulcer is nothing more 
than a healthy, granulating, and cicatrizing surface. The 
granulations are small, numerous, florid, and pointed, and 
yield a moderate secretion of healthy pus. This may be 
termed a common sore, healing properly. 

Treatment. Simply protect the part from the air, by 
lint dipped in tepid water ; or, if in hot weather, use the 
following preparation : — 

Take of Carbolic Acid, .... 1 drachm. 
Glycerine, .... 4- ounce. 
Water, 1£ ounces. 

Mix. This makes an excellent dressing for ulcers. A 
piece of linen spread with simple cerate is also a good dress- 
ing for a healthy ulcer. 

INFLAMED ULCER. 

Symptoms. The margin of the sore is ragged, the skin 
ending in a sharp edge around it. The neighboring parts 
are red, swollen, and painful ; and the bottom of the ulcer is 
uneven, and covered with a white spongy substance. In 
place of healthy, yellowish pus, it discharges a thin fluid ; 
the surface of it bleeds on the slightest touch. 

Treatment. Keep the patient quiet, and on a low diet ; 
administer a purgative, and apply to the ulcer a poultice of 
flaxseed meal or slippery-elm. When the inflammation has 
subsided, and healthy yellow matter is formed, omit the 
poultice, keep the sore clean, and use the dressing advised 
for simple healthy ulcer. 



INDOLENT ULCER. 311 



FUNGOUS ULCER. 



Symptoms. The presence of large, round granulations, 
rising above the level of the adjoining parts, or what is com- 
monly called " proud flesh" marks this species of ulcer. 

Treatment. Burnt alum and blue vitriol are sometimes 
used to destroy the proud flesh ; but the nitrate of silver 
(lunar caustic), passed lightly over the surface of the ulcer, 
is preferable. After the caustic has been applied, dress the 
sore with simple cerate, and pass a bandage firmly over the 
whole. Dress it daily. 

SLOUGHING ULCER. 

Symptoms. The mortification or death of parts of an 
ulcer, which fall off. It is generally attended by fever and 
pain. 

Treatment. The diet should be generous, and iron and 
quinine may be given to strengthen the system. Porter or 
ale may also be taken. 

Cauterize the ulcer thoroughly with nitrate of silver, and 
apply warm flaxseed poultices. Wash the ulcer daily with 
the following : — 

Take of Liquid Chloride of Soda, . . 1 ounce. 

Water, 7 ounces.' 

Mix. 

When the dead portions have all fallen off, treat it as a 
simple ulcer, paying attention, however, to the state of the 
system. 

INDOLENT ULCER. 

Symptoms. The edges of the skin are thick, raised, 
smooth, and shining. The points of new flesh are glossy, 
and the appearance of the ulcer is that of an old one in which 
the healing process is at a stand. 

Treatment. Touch the whole surface, sides, and edges of 
the sore with lunar caustic, or blue vitriol, and endeavor to 



312 MEDICAL AND SURGICAL COMPANION. 

rouse the parts to action. If one article fails, try another. 
Strips of adhesive plaster may be passed over the ulcer, about 
a third of an inch apart, so as to draw its edges nearer to- 
gether, and a bandage be applied over the whole. When 
the healing process begins to go on properly, dress as a 
simple ulcer. 

VARICOSE ULCER. 

This is dependent upon a varicose or enlarged condition of 
the veins, and usually occurs in the leg, just above the ankle. 
It is oval and superficial, and attended with deep-seated, 
aching pain. The ulcer is indolent, and generally moist upon 
the surface. 

Treatment. The permanent cure must depend upon re- 
moving the disease of the veins. Much relief will be found 
in the constant use of cold water, rest, regular bandaging, or 
laced stockings. Keeping the part elevated, and washing it 
twice a day with water containing sugar of lead in solution 
(one drachm to a pint), and protecting it from the air by a 
cloth smeared with simple cerate, will often cause it to heal 
temporarily. 

CARIOUS ulcer. 

Symptoms. Ulcers situated over or near carious (or dead) 
bone, are thereby prevented from healing. They frequently 
penetrate to some depths into the parts, forming a canal, with 
hard and indolent sides, which discharges an offensive, un- 
healthy matter. 

Treatment. Keep the ulcer clean, repress any fungous 
or "proud flesh" that may arise, and pay attention to the 
general health of the patient, taking care that his strength be 
kept up, if necessary, by iron, quinine, wine, porter, &c. 
The ulcer will not permanently heal until all the pieces 
of dead bone are thrown off". Whenever an ulcer proves 
obstinate, consult a physician. 



DISEASES OF THE BONES. 313 



CHAPTER VI. 
DISEASES OF THE BONES. 



Caries is an ulceration of the bone. The disease most 
frequently attacks the thick bones, and the extremities of 
long bones. It is attended with pain and swelling, and there 
is often a fetid discharge, containing portions of bone. 

Causes. Local injury ; constitutional affections, such as 
scrofula and syphilis. 

Treatment. If caused by constitutional trouble, change 
of air, tonics, and alteratives will be required. If scrofula 
is the cause, use the remedies and measures directed for that 
disease. If syphilis is performing the work, the treatment 
directed for the tertiary form of that disease will be proper. 

In obstinate cases, surgeons expose and remove the whole 
of the diseased portion of bone by the saw, or gouge, or 
trephine. 

NECROSIS. 

By necrosis, is meant the death of the bone, which is often 
enclosed in a case of new bone. Sometimes the dead parts 
separate from the living in the same manner as dead flesh. 
The dead pieces are thrown off, and make their way to the 
surface. It occurs at all ages, and most frequently in the 
compact bones. It is attended with swelling, and a discharge 
of matter through openings, in the case of new bone. 

For treatment, apply to a surgeon. You can do nothing 
yourself, more than to keep your general health good. 



314 MEDIC4L AND SURGICAL COMPANION. 

BRITTLENESS OF BONES. (FRAGILITAS OSSIDM.) 

Brittleness of bones frequently occurs in youth, but 
oftener in old age. A hasty step, turning in bed, or tripping 
on a carpet, may produce fracture. 

Causes. Long confinement, scrofula, intemperate habits, 
cancerous affections, &c. 

Treatment. Set the fracture as usual. In old persons, 
all that can be done in the way of general treatment is to 
guard against any accident, and to enjoin a generous diet 
and salubrious atmosphere. In scrofulous children, a good 
diet, pure air, and tonics are proper. 

SOFTENING OF BONES. (MOLLITIES OSSIUM.) 

This is a deficiency of the earthy matter of bones, and 
hence they are soft and pliable. This disease affects adults, 
and its course is generally rapid. The bones are light, soft, 
and frequently consist of an external shell, filled with soft, 
fatty matter. The general health is much impaired ; and 
flesh, spirits, and strength diminish daily. The cause is ob- 
scure. 

The treatment is merely palliative, the disease being in- 
curable. Tonics, good food, and pure air will prove ser- 
viceable. 

RICKETS. (RACHITIS.) 

This is a disease peculiar to youth and scrofulous tempera- 
ments. There is an original defect of the skeleton or bones. 
This disease often gradually increases with age, and hence 
great deformity of the limbs and curvatures of the spine, &c, 
occur. 

In adult life, the general health may be regained, and the 
patient, though much deformed, prove a healthy, muscular, 
and active person. 

Treatment. Do everything possible to improve the 
general health. A reasonable amount of exercise in the open 



DISEASE OP THE HIP JOINT. 315 

air is essential. The diet must be generous, and should con- 
sist, to a considerable extent, of animal food of easy diges- 
tion. 

Mechanical apparatus, properly constructed, may in some 
cases be of service in preventing permanent deformity. 

DISEASE OP HIP JOINT. (COXALGIA.) 

This is a disease common to scrofulous children. 

Symptoms. At the commencement there is slight pain, 
referred to the knee ; some lameness and stumbling in walk- 
ing ; usually tenderness in groin, and pain is produced by 
suddenly pressing upon the head of the bone ; and the limb 
appears lengthened. Unless the disease is arrested, the head 
of the bone and its socket become destroyed, and the thigh 
bone is drawn up, constituting a spontaneous dislocation. 
Frequently an abscess forms, and opens externally. 

Treatment. Leeches over the joint may be useful at 
first. Subsequently more benefit will be derived from 
counter-irritation by blisters and issues. The patient often 
has to be confined to the bed for a considerable time, the 
limb being kept in a proper splint. The bowels may be 
regulated by laxatives. Tonics and alteratives are the con- 
stitutional remedies. This disease may last for months, or 
even years. Always consult a surgeon for this disease. 



316 MEDICAL AND SURGICAL COMPANION. 



CHAPTER VII. 
MISCELLANEOUS SURGICAL DISEASES. 

TUMORS. 

By the word tumor, is meant an enlargement or swelling 
of any part of the body. They are of different kinds, arise 
from various causes, and are more or less dangerous, ac- 
cording to their nature and the place they occupy. 

Tumors sometimes derive their names from the substance 
of which they are composed, as fleshy tumor, fibrous tumor, 
fatty tumor, &c. Cystic tumors are those which consist of 
a sac, containing solid or liquid substances. 

Treatment. Apply to a surgeon. 

ANEURISM. 

An aneurism is a pulsating or beating tumor, filled with 
blood, which communicates with an artery. It is without 
pain or redness, and if small, will disappear on pressure, 
but return the moment it is removed. It is generally found 
in the neck, ham, bend of the elbow, or connected with the 
large artery (aorta) leading from the heart. An aneurism 
may be true or false. A true aneurism consists of the dila- 
tation of one or more of the coats of the artery. A false 
aneurism arises from the escape of blood from the artery 
into the surrounding tissues. It may be caused by a wound 
of the artery, or from an external ulcer perforating its coats. 

Treatment. Do not tamper with it yourself, but apply 
to a surgeon as soon as convenient. 



POLYPUS. CANCER. 317 



POLYPUS. 

Polypus is an empirical and antiquated term, employed to 
signify any sort of tumor attached to a surface by a pedicle. 
These tumors are frequently found in the nose, on the neck 
of the uterus, and some other mucous surfaces. As soon as 
any affection of this kind is suspected, apply to a surgeon. 



CANCER. 

Cancer is a term applied to several kinds of malignant 
disease ; and under this term are included several morbid 
growths, — encephaloid, scirrhus, and colloid, — whose phys- 
ical characters are so various, that they were formerly con- 
sidered separate affections. Of all the forms of cancer, 
the encephaloid, or soft cancer, runs the quickest course, is 
the most malignant, and causes death in much the shortest 
time. 

Scirrhus, or hard cancer, does not attain so large a size as 
encephaloid, and runs its course more slowly. 

Colloid is a variety of cancer which consists of a jelly- 
like matter. It is most frequent in the intestinal canal. 

Cancer may affect almost any part or organ of the body. 
The eye, lip, testicle, female breasts, womb, lungs, stomach, 
liver, and kidneys may all be affected by this much-dreaded 
disease. 

Cause. Unknown. 

Symptoms. When this affection has become fully devel- 
oped, the patient generally bears on his countenance a plain 
token of a formidable disease ; the features are shrunken 
and anxious, the complexion sallow, and emaciation is be- 
ginning to be realized. Pain is almost always considerable, 
often severe and cutting. 

Treatment. No radically curative measure, such as is 



318 MEDICAL AND SUKGICAL COMPANION. 

capable of removing the cancerous taint from the blood, and 
of arresting the growth of the local disease, is known. All 
that Ave can do is to check the disease so far as we are able, 
and make the patient's life as long and as comfortable as our 
means permit. 

If a person has a cancerous affection of the lip, breast, or 
any external part, its early and thorough removal may tend 
to prolong life. The general health should be improved, 
and the patient may never be troubled again by the disease ; 
but it must be remembered that removing the local manifes- 
tation of the affection does not remove the cancerous taint 
from the blood ; consequently, the disease may reappear, 
after a longer or shorter time, either in the old spot, or some 
other locality. 

When a cancer has become an open sore, and its removal 
is not thought advisable, it should be treated like any other 
foul ulcer. It should be cleansed once or twice a day by a 
weak solution of the chloride of soda. One ounce of the 
liquid to eight of water will make a good wash. After it 
has been thoroughly cleansed, it may be dressed with sim- 
ple oiutment, or a poultice of flaxseed meal applied, as occa- 
sion may seem to require. If painful, opiates may be taken 
as often as may be necessary. 

No person should tamper with a cancerous disease, but 
seek the advice and guidance of a regular physician, when- 
ever possible. The country abounds in quack " cancer 
doctors," who, I believe, are accustomed to call almost every- 
thing in the form of a tumor or sore, a cancer, or " cancer- 
ous ; " consequently they often obtain the credit of curing a 
cancer, when the affection treated was of a benign instead of 
a malignant character. No " cancer doctor," so far as I 
know, has ever received a regular medical education ; con- 
sequently, it would be unreasonable to suppose them to 
understand the nature and proper treatment of cancers, any 
better, if so well, as physicians who have. 



FISSURE OF THE ANUS. 319 



PILES. {Hemorrhoids.) 

Piles,- or hemorrhoids, are small tumors, which arise in 
and about the lower end of the bowels. They are composed 
of a congeries of varicose or enlarged veins, surrounded by 
condensed cellular tissue. In some instances they are with- 
out the verge of the anus, and in others within it. The first 
are called external, and the second internal piles. In some 
cases bleeding occurs from ulceration of the skin or mucous 
membrane covering them. They are then termed bleeding 
piles. When they do not bleed they are called blind piles. 

Causes. Costiveness, intemperance in eating and drink- 
ing, strong purgatives, fulness of blood, and an inactive, 
sedentary life. 

Treatment. Regulate the bowels by laxatives, and take 
a cold-water injection once or twice a day, just previous to 
evacuating the bowels. If there is much soreness about the 
verge of the anus, apply the following ointment night and 
morning, after evacuating the bowels : — 

Take of Ointment of Galls, . . .1 ounce. 
Powdered Opium, . . .8 grains. 
Mix. 

Persons troubled with piles should endeavor to avoid every- 
thing which tends either to produce or aggravate them. 

Piles sometimes become so large and troublesome as to 
require removal. In bad cases apply to a surgeon. 



FISSURE OF THE ANUS. 

This is an ulceration or cracking of the skin and mucous 
membrane on the verge of the anus, and is attended with 
severe pain, especially when the bowels move. It very often 
results from dyspepsia. 

Treatment. Alteratives and laxatives may be given to 



320 MEDICAL AND SURGICAL COMPANION. 

bring the bowels into a healthy condition. The ulcer or fis- 
sure may be gently touched with nitrate of silver (lunar 
caustic), after which apply the ointment recommended for 
piles. 

FISTULA IN ANO. 

This disease generally commences as an abscess by the 
side of the rectum. It usually begins with a hard, circum- 
scribed, red, painful bunch or tumor, very near the entrance 
to the bowel. It will often create a high fever, quick, forci- 
ble pulse, and extreme pain, especially when the contents of 
the bowels are discharged. 

Treatment of the Abscess. The patient should keep 
quiet, and partake of light food. The bowels may be moved 
by a dose of castor-oil or Epsom salts ; after which, warm 
fomentations and poultices may be applied to the tumor. As 
soon as the matter is formed, it should be let out with the 
lancet. The opening must be large enough to prevent the 
formation of more matter, 

Abscesses, boils, &c, may form about the extremity of 
the rectum or bowel, and go on to suppuration, and dis- 
charge their contents, and heal, the same as similar affec- 
tions in other localities. But when healiug does not take 
place, and an opening or canal is left by the side of the 
bowel, discharging matter, a person is said to have a fistula. 
If this canal opens into the bowel, it is called a complete fis- 
tula. When it does not, it is termed a blind external fistula. 
When there is an opening into the bowel, but not externally, 
we have a blind internal fistula. 

In complete fistula there is a frequent discharge of pus, 
mucus, feces, and wind, and it is attended with heat, uneasi- 
ness, and pain. 

Treatment of the Fistula. The proper remedy for 
complete fistula is division of the sphincter ani, or muscle 
which surrounds the bowel, so as to prevent its contraction 



BOILS. 321 

for a time, and allow the wound to heal from the bottom. 
By this process the fistulous opening becomes obliterated, 
and the patient relieved of a very annoying disease. If 
propeidy treated, fistula in ano is not the serious disease 
which it is commonly supposed to be. 

Fistula and disease of the lungs often coexist, and in such 
cases, to cure the fistula may tend to increase or hasten the 
development of the lung trouble. All persons afflicted with 
this disease should consult a reliable physician, who will 
give due weight to all the circumstances and complications 
attending it, and advise accordingly. 



BOILS. (Furunculus.) 

A boil is a painful, hard, circular, red tumor, which gen- 
erally maturates, and discharges, together with pus, a kind 
of core. They vary in size, but are not often larger than an 
English walnut. They generally come singly, but in some 
cases several may appear at the same time. They occur 
most frequently in young persons, and in those of plethoric 
habit, and in those parts where the skin is thickest. 

Treatment. Poultices and warm fomentations should be 
applied early ; as soon as pus has formed, a free incision 
through the tumor must be made. After the " core " has 
been discharged, dress with simple cerate, or resin ointment. 
Boils arise from some disorder of the blood, occasioned by 
unwholesome food, or some unknown depressing influence. 
They frequently follow bowel complaints, fevers, small-pox, 
measles, and some other diseases. 

When boils begin to make their appearance, the bowels 
should be opened by a good purgative, and the patient's diet 
must be wholesome and liberal. 

The preparations of iron and quinine are beneficial for 
debilitated patients. 
21 



MEDICAL AND SURGICAL COMPANION. 



CARBUNCLE. (Anthrax.) 

A carbuncle is a hard, painful, deeply-seated tumor, which 
appears most frequently on the back and shoulders. It re- 
sembles, in many respects, a large boil. After a few days 
the surface assumes a livid redness, and a spongy feel ; a 
white discharge takes place through a number of little ori- 
fices, formed in the swelling ; a dark-colored core appears in 
the centre ; and a fetid smell gives warning of dead matter 
beneath the surface. The discharge resembles whey, witli 
atoms of curd in it. When large, it is liable to be attended 
with violent fever, followed by great, and sometimes fatal 
prostration of strength. 

Treatment. In some cases it is beneficial to cut through 
the tumor whilst hard and brawny ; in other cases, it may 
be better to defer this till suppuration has commenced, and 
then to make a crucial incision through the infiltrated tis- 
sues, so as to insure a free discharge of all pus and dead 
flesh. After opening, apply warm poultices, &c, as directed 
for boils. 

This is a blood disease, and will require tonics, such as 
iron, quinine, &c. When the prostration is great, wine or 
brandy will be necessary. If the pain is severe, laudanum or 
morphine may be taken in proper doses. It is always well to 
open the bowels with a proper cathartic at the commencement 
of the disease. The following may be as good as any : — 

Take of Blue Mass, 3 grains. 

Extract of Jalapa, . . . . 2 grains. 

Mix. Three hours after taken, give half an ounce of 
castor-oil, or a Rochelle powder. 



CHILBLAINS. (Pernio.) 

This is an affection of the skin, produced by sudden alter- 
nations of cold and heat. The heels, toes, ears, or fingers 



FELON. WHITLOW. 323 

are the parts usually affected. It is attended with itching, 
swelling, pain, &c. 

Treatment. "With a camel's-hair brush, paint the parts 
over daily, for two or three days, with tincture of iodine ; or 
apply the following liniment night and morning : — 

Take of Spirit of Turpentine, . . . 1£ ounce. 

Spirit of Camphor, . . . £ ounce. 

Mix. 

FROST BITE. 

When a part of the body is frost-bitten, it becomes con- 
tracted, pale, and insensible. It may take place without the 
consciousness of the patient. If care is not taken, it may 
end in mortification of the part. 

Treatment. First rub the part with snow, and then with 
cold water, in a room without fire. Afterwards apply a 
little spirit and water. 



FELON. WHITLOW. {Paronychia.) 

This is a painful, inflammatory swelling, affecting the end 
of the finger or root of the nail. It is painful and trouble- 
some in proportion as it is more or less deep seated. Where 
only the skin is inflamed, it is soon well ; but where the in- 
flammation is deep in the flesh, and reaches the bone, it is 
very painful, and long in suppurating. When the inflamma- 
tion is near the surface, the skin is red ; but if deep-seated, 
there is little or no appearance of redness, although the 
swelling be considerable. 

Treatment. If the disease is superficial, holding the part 
in hot water, or bathing it with spirit, may cause it to disap- 
pear ; but if deep-seated, a leech or two may be applied to 
the part, and the patient may take a good dose of Epsom 
salts, and observe a low diet for a few days. But if these 



324 MEDICAL AND SURGICAL COMPANION. 

measures fail to give relief, a deep and free incision must be 
made into the part, and bleeding be encouraged by holding 
the finger in warm water. A poultice of flaxseed or slippery- 
elm may then be necessary, for a few days. Soaking the 
finger in warm soap suds for fifteen minutes, night and morn- 
ing, will prove beneficial. Laudanum may be taken to relieve 
pain, and the surface of the poultice may also be wet with it. 
A felon sometimes causes the loss of one of the bones of 
the finger ; and when it proves obstinate, apply to a surgeou. 



WEN. 

A wen is a tumor or swelling formed upon the surface of 
the body ; most commonly upon the head, neck, shoulders, 
and back. 

They may grow to an enormous size, but those usually 
seen are about half as large as a hen's egg. They are 
usually of a round, or oval shape, but sometimes have a neck, 
and are shaped like a pear. Some of them consist of a 
substance which resembles the curd of cheese, enclosed in 
a sac. 

Treatment. The only sure remedy is to have them ex- 
tirpated by the knife. In cutting them out, it is of the utmost 
importance to dissect out all the sac in which they are con- 
tained, otherwise they may grow again. For this treatment 
apply to a surgeon. 

WARTS. 

Warts consist in an enlargement of the papillae and cuticle. 
The commonest variety is the wart which frequently grows 
on the hand. 

Treatment. If necessary to interfere, warts may be 
snipped off, and the points from which they sprung touched 
once or twice with lunar caustic, or nitric acid, to prevent 
their recurrence. Touching them twice a day with tincture 



CORNS. BUNION. 325 

of iodine will generally soon cause them to disappear ; but 
they often return obstinately, in spite of treatment, and fre- 
quently disappear of themselves when let alone. 



CORNS. 

Corns are growths of thick cuticle, not merely lying upon 
the true skin, but penetrating into it. They are produced 
when the skin, situated over some projecting point of bone, 
is irritated by pressure or friction. Their usual seat is on 
the joints of the toes, and tight boots or shoes are their usual 
cause. They are divided into two kinds, the hard and the 
soft. The hard is situated on the surface of the foot, where 
the cuticle can become dry and hard ; the soft, between the 
toes, where the cuticle is soft and spongy. 

Treatment. Lay aside the boots or shoes which have 
caused them, and wear only such as are properly adapted to 
the size and shape of the feet. For the removal of the exist- 
ing corns, soak them well in warm water, and then, with a 
very sharp knife, pare them down to a level with the sur- 
rounding skin. By afterwards wearing boots or shoes of 
proper size, the remaining hardness will soon disappear. A 
professional " corn doctor " will sometimes remove the whole 
corn at once, without causing much pain. But, however re- 
moved, it will return again if boots or shoes of improper size 
are worn. 

BUNION. 

A bunion is a swelling about the joint which connects the 
great toe to the foot. It is often very annoying and ex- 
tremely painful. It may arise from several causes. 

Treatment. Wear properly fitting boots or shoes, and if 
the part is painful, painting it with tincture of iodine once or 
twice a day, for a few days, may prove beneficial. It will 
be well to consult a surgeon as soon as convenient. 



326 MEDICAL AND SURGICAL COMPANION. 



IN-GROWING TOE NAIL. 

This is a very painful affection, generally the result of 
wearing tight boots or shoes. It is usually accompanied 
with more or less inflammation, and at times ulceration. 
Fungous growths or proud flesh may appear, and the pain 
become so severe as to render the patient unable to walk or 
wear a shoe. 

Treatment. If the part is inflamed, soak ft in warm 
saleratus water, daily, for twenty minutes each time ; after 
each soaking, a poultice of slippery-elm may be applied, and 
changed two or three times a day. As soon as this course 
has removed the inflammation, then, after each bathing or 
soaking of the part, press some lint under the embedded 
portion of the nail, so as to elevate it as much as possible, 
without occasioning too much pain. The elm poultice may 
be continued if the part remains painful. Dress it thus once 
or twice a day. Any fungous or "proud flesh" may be de- 
stroyed by the nitrate of silver — lunar caustic. The object 
of the above treatment is to raise the nail from the flesh, that 
it may be cut off in small pieces from time to time, continu- 
ing the introduction of the lint, and cutting off the nail, until 
the offending portion of it has been removed. After the tiail 
has been sufficiently removed, and the proud flesh destroyed, 
the part readily heals. It will be well, at the commence- 
ment, to scrape the nail along its middle, until it is as thin as 
writing paper, as it will then readily bend under slight pres- 
sure. It sometimes requires a long time to effect a permanent 
cure. If tight boots or shoes are again worn, the difficulty 
will return. 



CARE OF THE FEET. 

The feet should be washed every day, especially in warm 
weather, care being taken to prevent any lodgment of filth 



PRESERVATION OF THE TEETH. 327 

between the toes. After washing, wipe and dry them thor- 
oughly. The nails of the toes require as much care as those 
of the fingers : they should never be allowed to grow too 
long, but should be properly cut as often as they require it. 
The stockings may be made of cotton or woollen, the former 
being better suited for warm weather, and the latter for cold. 
They should be frequently changed. 

The feet of many persons sweat excessively, and occasion 
disagreeable sensations, as well as an unpleasant odor, 
especially if they are inattentive to cleanliness. This may 
be lessened by daily washing the feet with soap and water, 
or with water containing a little solution of chloride of soda. 
Two tablespoonfuls of the solution to a pint of water will be 
sufficient. 

In cold or wet weather, thick boots or shoes should be worn, 
and when the walking is very bad, rubbers may be put on 
over them. There is nothing lost by keeping the feet dry 
and warm. 

When the feet become casually wet, the shoes and stock- 
ings should be at once removed, the feet bathed in warm 
water, and thoroughly dried by considerable friction with a 
coarse towel, and by holding them to the fire. This course 
will tend to prevent colds and coughs. 

RULES FOR THE PRESERVATION OF THE 
TEETH. 

Rule 1. Be careful not to hold any fluid or solid sub- 
stance in the mouth, either too hot or too cold ; and be very 
particular not to bite or crush any hard substances, as nuts, 
&C, with the teeth. 

Rule 2. Do not allow acid substances or sour drinks to 
remain in contact with the teeth. After using such, rinse 
the mouth well with water, in which may be dissolved a 
little saleratus, or bicarbonate of soda. 

Rule 3. At least once a day, clean the teeth with a tooth- 



328 MEDICAL AND SURGICAL COMPANION. 

brush, using some one of the tooth powders mentioned under 
the head of " Miscellaneous Recipes," in the latter part of this 
book. 

Rule 4. As soon as a carious spot is observed on a tooth, 
go to a dentist's and have it filled. 

Rule 5. Whenever a tooth has become too much de- 
cayed to be preserved by filling, and is giving you pain, have 
it extracted without delay. Allow no badly decayed teeth 
or old " stumps," to remain in your mouth, to render your 
breath offensive and impair your health. 



PART III. 



CHAPTER I. 
RECIPES. PRESCRIPTIONS. MEDICINES. 

The following Recipes or Prescriptions are referred to by 
numbers, throughout the pages of this book, — R standing 
for Recipe. 

1. EMETICS. 

Emetics are medicines which excite vomiting. They may be 
used to empty the stomach when any indigestible substance is caus- 
ing distress, and sometimes they are beneficial in the first stage of 
fever ; also in bronchitis, croup, &c. A prompt emetic is very es- 
sential in cases of narcotic poisoning, as by opium, laudanum, mor- 
phine, or belladonna. 

No. 1. Powdered Ipecac. 

This is a very useful and safe emetic, and may be given in all 
ordinary cases. An adult may take twenty grains in molasses, or 
sugar and water. When nausea begins to manifest itself, the pa- 
tient may drink freely of warm water, to promote vomiting. If one 
powder does not produce the desired effect within one hour, a 
second may be taken in like manner. 

No. 2. Wine of Ipecac. 

Dose for an adult, from one ounce to one ounce and a half. For 
children, one to two teaspoonfuls, repeated every ten or fifteen 
minutes, until vomiting takes place. Warm water may be taken as 
recommended above. 

(329) 



330 MEDICAL AND SURGICAL COMPANION. 

No. 3. Powdered Black Mustard. 

Take a teaspoonful or two in a teacupful of warm water, every 
five or ten minutes, until free vomiting takes place. The patient 
should drink feeely of warm water, so that the stomach may be well 
washed out. This is a very prompt and safe emetic, and may be 
used in cases of poisoning by opium or other narcotics. From 
thirty to sixty grains of sulphate of zinc may be used instead of 
the mustard, when at hand. 

2. CATHARTICS. 

Cathartics are medicines which evacuate the bowels. They 
also fulfil other indications not necessary to be mentioned in this 
work. 

No. 4. Compound Cathartic Pills. 

These are kept by all apothecaries. Dose, for an adult, two or 
three. A safe and efficient purgative. 

No. 5. Purgative Powder. 

Take of Powdered Jalap, -J ounce. 

Powdered Alexandria Senna, . . 1 ounce. 
Powdered Cloves, 30 grains. 

Mix. Dose, for an adult, a teaspoonful or more. It may be 
taken in molasses, or steeped in a teacupful of boiling water, for an 
hour, and drank when cold. 

This is an excellent purgative, and may be given to children 
without difficulty, owing to the pleasant taste of the tea. A child 
of five years may take about one fourth of a teaspoonful ; a youth 
of fourteen years, one half teaspoonful. 

No. 6. Epsom Salts. (Sulphate of Magnesia.) 
Dose, for an adult, one ounce, dissolved in a tumblerful of water. 
Take on an empty stomach. A quick purgative, useful in fevers 
and inflammations. 

No. 7. Castor Oil. 

Dose, for an adult, one ounce, or two tablespoonfuls. For chil- 
dren, from one teaspoonful to a tablespoonful, according to age. 

This is a mild and excellent purgative for children, old people, 
and persons who are much debilitated. 



RECIPES. PRESCRIPTIONS. MEDICINES. 331 

No. 8. JRochelle or Seidlitz Powders. 

One may be taken before breakfast, when a laxative is required. 

3. INJECTIONS. (Enemata.) 

Injections are used either as auxiliaries to, or substitutes for, ca- 
thartics, for the purpose of procuring a discharge from the bowels. 
They are also occasionally used for other purposes. 

The quantity required for a child between the ages of one and 
five years, is about one gill ; for a youth twelve to fifteen years, 
half a pint ; for an adult, from a pint to a quart or two, according 
to circumstances. In all cases, a warm folded towel should be 
firmly pressed against the anus or bowel, for fifteen or twenty min- 
utes after the injection is thrown up. 

The Syringe or Injection Pipe. This is an article which every 
family should have, and keep in good order, as it is often very useful 
in sickness. No traveller should proceed on his journey without one. 
The best syringe now in the market, known to the writer, is the Da- 
vidson Syringe ; but a common instrument will answer very well. 
After using a syringe, it should always be well cleaned and carefully 
dried before being put away. 

No. 9. Warm Water. 

This is a very simple and useful injection, and may be used to 
relieve constipation, or aid cathartics. A little soap may sometimes 
be added to advantage. 

No. 10. Cold Water. 

This is a useful injection in piles (hemorrhoids), especially the 
internal, or bleeding kind. It should be used just previous to evac- 
uating the bowels. 

No. 11. Salt and Water. 
Take of Common Fine Salt, .... 1 ounce. 
Warm Water, . . . .1 quart. 

Mix. An excellent injection for " Pin Worms." 

No. 12. Purgative Injection. 

Take of Castor Oil, 2 ounces. 

Molasses, ..*... 4 ounces. 

Common Fine Salt, . 1 ounce. 

Warm Water, 1 pint. 

Mix. One half may be given to an adult at once, and the remain- 
der in half an hour, if the first produces no evacuation. 



332 MEDICAL AND SURGICAL COMPANION. 



4. DIURETICS. 

Diuretics are medicines which promote the secretion of urine. 
They are sometimes useful in dropsical affections, fevers, and in- 
flammations. 

No. 13. Sweet Spirit of Nitre. {Spirit of Nitric Ether.) 
Dose for an adult, from one half teaspoonful to a teaspoonful. 
It may be taken two or three times a day when necessary. Use- 
ful in fevers, inflammations, dropsical affections, &c. 

No. 14. Parsley Root. 

Take of Parsley Eoot (bruised), . . . 1 ounce. 
Boiling Water, 1 pint. 

Steep an hour or longer, and strain. A teacupful may be taken, 
either alone or with a teaspoonful of sweet spirit of nitre, every 
three or four hours. 

This is an excellent diuretic in dropsical affections. 

No. 15. Mixture of Acetate of Potassa and Spirit of 
Mindererus. 

Take of Spirit of Mindererus, .... 2 ounces. 

Acetate of Potassa, .... 2 drachms. 
Mix. Dose, a tablespoonful every three hours. 
Very good for gravel and lithic acid deposits. Also useful in 
fevers. 

No. 16. Mixture of Buchu and Uva Ursi. 

Take of Fluid Extract of Buchu, . . . \ ounce. 

Fluid Extract of Uva Ursi, . . . \ ounce. 

Syrup of Gum Arabic, .... 1 ounce. 

Spearmint Water, 2 ounces. 

Mix. Take two teaspoonfuls every three hours. Useful in gleet, 
atony and paralysis of the bladder. 

No. 17. 3Iixture of Copaiba. 

Take of Balsam of Copaiba 1 ounce. 

Sweet Spirit of Nitre, .... 1 ounce. 

Powdered Gum Arabic, . . . \ ounce. 

Powdered White Sugar, . . . \ ounce. 



RECIPES. PRESCRIPTIONS. MEDICINES. 



333 



Distilled Water, 4 ounces. 

Compound Spirit of Lavender, . . -| ounce. 

Tincture of Opium 2 drachms. 

Mix in a bottle. First the balsam and nitre ; then put into a 
mortar the gum arabic and sugar, and while mixing them with the 
pestle, add gradually the water. Continue the stirring until dissolved, 
then add to the balsam and nitre, and shake well ; lastly, add the 
spirit of lavender and tincture of opium. 

Shake before using. Useful in gonorrhoea. Dose, one table- 
spoonful three times a day. 

No. IS. Mixture of Copaiba, Cubebs, &c. 



Take of Balsam of Copaiba, 

Powdered Cubebs, 

Powdered Gum Arabic, 

Powdered White Sugar, 

Water, .... 

Camphorated Tincture of Opium, 
Mix. Shake before using. Take a tablespoonful three times a 
day. Useful in gonorrhoea and gleet. 

No. 19. Another Form. 

Take of Balsam of Copaiba, 
Oil of Cubebs, 
Liquor Potassae, . 
Sweet Spirit of Nitre, . 
Compound Tincture of Lavender, 
Tincture of Opium, 
Syrup of Gum Arabic, . 

Mix. Shake before using. Take one teaspoonful four times a 
day. For gonorrhoea and gleet. 



1 ounce. 
1 ounce. 
■£ ounce. 
\ ounce. 
14 ounces. 
1 ounce. 



1 ounce. 

2 drachms. 
2 drachms. 
\ ounce. 

2 drachms. 
2 drachms. 
\\ ounces. 



5. DIAPHORETICS. 

Diaphoretics are medicines which promote perspiration, or sweat- 
ing. 

No. 20. Dover's Powder. 

In doses of five to ten grains, this powder has a diaphoretic 
effect. To promote its operation warm drinks may be freely taken, 
but not immediately after the dose, lest vomiting be induced. 



334 MEDICAL AND SURGICAL COMPANION. 

No. 21. Siririt of Minder er us, Sweet Spirit of Nitre, 
<£c. 

Take of Spirit of Mindererus, . ... 2 ounces. 
Sweet Spirit of Nitre, .... 1 ounce. 
Tincture of Opium 1 drachm. 

Mix. A teaspoonful may be taken three -or four times a day, for 
fevers and inflammations. 

No. 22. Sweating Drops. 

Take of Powdered Virginia Snakeroot, . . 2 drachms. 

Powdered Ipecac, .... 2 drachms. 

Powdered Camphor, .... 2 drachms. 

Saffron, 2 drachms. 

Powdered Opium, .... 2 drachms. 

Hollands Gin, or Diluted Alcohol, . . 12 ounces. 

Mix, and let stand fourteen days, shaking occasionally ; then ex- 
press, and filter through paper. This is an excellent preparation, 
and may be used in most cases where a diaphoretic is required. It 
also lessens pain, allays nervous excitability, and promotes sleep. 
One teaspoonful may be taken in warm water, every third or fourth 
hour. The feet may be well soaked in hot water previous to taking 
the drops, and, while in bed, a hot brick, flat-iron, or bottle of hot 
•water should be placed to them. 

No. 23. Sweet Spirit of Nitre. 

Half a teaspoonful to a teaspoonful, once in three or four hours, 
will act as a gentle diaphoretic. "Warm sage or pennyroyal tea 
will promote its operation. 

INFUSION OF SAGE OR PENNYROYAL. 
Both sage and pennyroyal are good diaphoretics. One ounce of 
either may be steeped for half an hour in a pint of boiling water ; 
then strain, and drink freely while warm. Excellent to promote 
perspiration after exposure to cold. The patient should be in bed, 
well covered, and with a hot brick or flat-iron at his feet. 



BECIPES. PRESCRIPTIONS. MEDICINES. 335 



6. EXPECTOKANTS. 

Expectorants are medicines which promote mucous discharges 
from the air passages and lungs. They are " cough medicines," 
and require to be repeated every two to four hours. 

No. 2d. Syrup of Squills, Senega, and Ipecac. 

Take of Syrup of Balsam of Tolu, . . 1 ounce. 

Syrup of Squills, \ ounce. 

Syrup of Senega, . . . . .1 ounce. 

Syrup of Ipecac, -A- ounce. 

Paregoric, 1 ounce. 

Mix. Take a teaspoonful every three hours. 

No. 25. Syrup of Squills and Ipecac ivitli Paregoric. 

Take of Syrup of Squills, . . . ... 1 ounce. 

Syrup of Ipecac, 1 ounce. 

Paregoric, 1 ounce. 

Mix. This preparation is relaxing and soothing, and may be 
given with benefit, when the patient has a troublesome cough, with 
deficient expectoration. 

No. 26. Another. 

Take of Syrup of Balsam of Tolu, . . .1^ ounces. 

Syrup of Ipecac, 1 ounce. 

Syrup of Squills, ^ ounce. 

Camphorated Tincture of Opium, . . 1 ounce. 

Mix. Dose, for an adult, one teaspoonful three or four times a 
day. Children in proportion to age. 

No. 27. Mixture of Bloodroot, Wild Cherry , &c. 

Take of Acetate of Morphia, .... 2 grains. 

Tincture of Bloodroot, .... 2 drachms. 

Wine of Antimony, . .3 drachms. 

Wine of Ipecac, 3 drachms. 

Syrup of Wild Cherry, .... 3 ounces. 
Mix. Dose, a teaspoonful. Useful in catarrhal affections, bron- 
chitis, and influenza. 



336 



MEDICAL AND SURGICAL COMPANION. 



No. 28. Mixture tvith Bicarbonate of Soda, &c. 

Take of Bicarbonate of Soda, . . .36 grains. 
Wine of Ipecac, .... 1 drachm. 
Tincture of Opium, . . . .24 drops. 

Simple Syrup, \\ ounces. 

Pure Water \\ ounces. 

Mix. Give a teaspoonful every three hours. This preparation 
is designed for children, and is chiefly used in whooping-cough. 



7. INHALATION. 

Inhalation is a means of applying remedies directly to the air 
passages and lungs, and when judiciously used, in connection with 
other appropriate treatment, much benefit may be derived there- 
from. I will mention a few preparations which may, in appro- 
priate cases, be inhaled with benefit, in the form of vapor. A 
proper inhaler is requisite, and I know of no one superior to the 
kind which I use in my practice. The price is but one dollar 
($1.00), and it can be forwarded by Express to any part of the 
country. 

No. 29. Compound Mixture of Iodine. 

Take of Iodine, 6 grains. 

Iodide of Potassium, .... 12 grains. 

Distilled Water, 2£ ounces. 

Alcohol, 1 ounce. 

Fluid Extract of Conium, . . . ^ ounce. 
Mix. Shake before using. 

Put one to two teaspoonfuls of the mixture into the inhaler, and 
fill it about half full of hot water. Inhale ten or fifteen minutes, 
three times a day. 

In incipient consumption, chronic bronchitis, and obstinate 
coughs, this will generally prove very beneficial. It should not be 
used in cases where there is acute inflammation. 

No. 30. Soothing Inhalant. 

Take of Tincture of Opium, . . . .1 ounce. 
Tincture of Stramonium, . . .1 ounce. 
Tincture of Conium, .... 1 ounce. 
Mix. Use one teaspoonful, two or three times a day, in the same 
manner as directed to use the preceding mixture. 



RECIPES. PRESCRIPTIONS. MEDICINES. 337 

Useful in harsh coughs, in bronchitis and consumption. Excellent 
in some asthmatic cases. 

No. 31. Stramonium Inhalation. 

This is serviceable in Asthma. 

Smoke the dried leaves in a common tobacco pipe. Persons un- 
accustomed to the remedy find one pipeful sufficient, while others 
can bear three or four in the course of a day, during a fit of the 
Asthma. 

8. EMMENAGOGUES. 

Emmenagogues are medicines which promote the menstrual dis- 
charge, or restore it when entirely suppressed. 

_ZVb. 32. Tincture of Iron, Aloes and Myrrh, and 
Castor. 

Take of Tincture of Chloride of Iron, . . \ ounce. 
Tincture of Aloes and Myrrh, . . \ ounce. 
Tincture of Castor, .... 2 drachms. 
Mix. Take thirty drops in a wineglassful of water three times a 
day. 

This preparation is excellent in cases where there is general de- 
bility, &c. 

No. 33. Tincture of Aloes and Canella. (Picra.) 
A teaspoonful may be taken in sweetened water, three times 

a day. A very good remedy in many cases of suppression of the 

menstrual flow. 

9. ANTHELMINTICS. 

Anthelmintics are medicines which are taken to destroy and 
bring away worms from the alimentary canal. They are frequently 
termed vermifuges. 

No. 34. Mixture with Oil of Wormseed. 

Take of Oil of Wormseed, . . . . \\ drachms. 

Castor Oil, 3 ounces. 

Oil of Anise, 10 drops. 

Mix, and then add of Aromatic Syrup of llhubarb, 1 ounce. 
Shake the bottle well before using. Give a teaspoonful, night 
and morning, to a child 2 years old. An excellent preparation. 
22 



338 MEDICAL AND SURGICAL COMPANION. 

No. 35. Fluid Extract of PinJcroot and Senna with 
Santonin. 

Take of Fluid Extract of Pink and Senna, . . 2 ounces. 
Santonin, 16 grains. 

Mix. Give a child, two years old, a teaspoonful night and morn- 
ing, until purging takes place. This is very effectual for removing 
the common round-worm. 

No. 36. Mixture of the Extract of Male Fern. 

Take of Ethereal Fluid Extract of Male Fern, . -| drachm. 
Syrup of Gum Arabic, . . .1 ounce. 

Mix. Shake well before using. 

Take one half at bedtime, and the remainder early in the morn- 
ing, on an empty stomach. Used for tape-worm. If the worm 
does not come away in six or eight hours after the last dose, take 
some mild purgative, as castor-oil. 

For Pin-Worms. — Injections are the most certain of all 
remedies for ascarides, or " pin-worms." 

No. 37> Injection of Salt Water. 

Take of Common Fine Salt, 1 ounce. 

Warm Water, 1 quart. 

Mix. One half or even the whole may be injected into the bowel 
of an adult, and retained fifteen minutes, if possible. It should be 
repeated once or twice a day, for a week or two. When used for 
children, let the quantity be in proportion to age. If the general 
health is below the proper standard, it should be improved by tonics, 
and other appropriate measures. 

No. 38. Injection of Aloes. 

Take of Powdered Aloes, \ ounce. 

Water, 1 quart. 

Mix. Use in the same way as the preceding. 

10. STIMULANTS. 

No. 39. Stimulants 

Are medicines which increase and sustain the action of the heart. 
They are often useful in diseases characterized by great prostration, 



RECIPES. PRESCRIPTIONS. MEDICINES. 339 

and in convalescence from fevers, &c. Brandy, whiskey, wine, &c, 
are stimulants, and may be used in appropriate cases, in proper 
quantities, three to six times a day. The dose of brandy or whiskey 
should not, as a general rule, exceed one to two tablespoonfuls. If 
wine be used, about two ounces may be given. 

Alcoholic stimulants should not be continued longer than 
they are required as medicines, for the daily use of spirituous 
liquors, by persons in health, is very injurious, and tends to under- 
mine the constitution, and bring on serious and even fatal diseases 
of the brain, liver, and kidneys. 

No. 40. Wine Whey. 

Take of good milk, one half pint; heat to the boiling point; then 
add of sherry wine, one gill ; strain, and add of white sugar one 
ounce, and a little nutmeg. 

There are few mild stimulants more employed or more useful 
than wine whey. The dose must be regulated by the circumstances 
of the case. From one gill to a pint may be taken during the day. 

No. 41. Egg -Nog. 

Take of the White and Yolk of . . . .4 eggs. 

White Sugar, 1 ounce. 

Beat well together, then add, 

Sherry Wine, 2 ounces. 

Water, 4 ounces. 

Grated nutmeg to taste. 

The above is sufficient for about four doses. Stimulant and nu- 
tritious. 

No. 42. Millc Punch. 
Take of Good Brandy, 1 gill. 

Fresh Milk, \ pint. 

White Sugar 1 ounce. 

A little grated nutmeg. 
Mix. A tablespoonful or more may be taken every hour or two 
in low fevers, and other diseases characterized by great prostration. 

No. 43. Mixture of Carbonate of Ammonia. 

Take of Carbonate of Ammonia 2 drachms. 

White Sugar, 3 drachms. 

Powdered Gum Arabic, .... 3 drachms. 

Spearmint Water, \ pint. 

Mix. Give a tablespoonful every two hours. 



340 MEDICAL AND SURGICAL COMPANION. . 

As carbonate of ammonia sustains the action of the heart, with- 
out stimulating the brain, it may be resorted to whenever the vital 
powers begin to fail, in diseases of nearly every type. 

11. NARCOTICS. 

Narcotics are medicines which are used to procure sleep, allay 
pain or spasm, arrest inordinate secretion, and control inflammatory 
action or irritation. 

No. 44. Pills of Opium. 

Take of Powdered Opium, 12 grains. 

Powdered Castile Soap, .... 3 grains. 
Mix, and form into twelve pills. 

One is the ordinary dose for an adult to produce sleep, allay pain, 
&c. 

No. 45. Pills of Sulphate of Morphia. 
Take of Sulphate of Morphia, .... 2 grains. 
Confection of B-ose, . . . .24 grains. 

Mix, and divide into 12 pills. 

One may be taken for a dose to allay pain, procure sleep, or 
check vomiting. If relief is not obtained in one hour, give the 
second pill. Except in severe cases, they should not be repeated 
oftener than every three to six hours. They should never be taken 
unless actually required. 

No. 46. Pills of Camphor and Opium. 

Take of Powdered Camphor, .... 2 scruples. 

Extract of Opium, .... 8 grains. 

Add of mucilage of Tragacanth, a sufficient quantity to form a 
pill mass. Divide into sixteen pills. Take two pills every night at 
bedtime. Used for spasm of the urethra, and to prevent nocturnal 
erections, or chordee. 

No. 47. Dover's Powder. 

The ordinary dose for an adult is ten grains, to promote sleep, 
allay pain, &c. It may be mixed with molasses or sugar and water. 

No. 48. Pills of Camphor, Assafoztida, <Ec. 

Take of Powdered Camphor, .... 1 drachm. 

Powdered Assafoetida, 1 drachm. 

Extract of Belladonna, -| drachm. 

Extract of Opium, . . . .10 grains. 

Mix thoroughly, and divide into sixty pills. One pill may be 






RECIPES. PRESCRIPTIONS. MEDICINES. 341 

given morning and night, or at shorter intervals, according to the 
urgency of the case. 
Used in hysteria, &c. 

No. 49. Laudanum. {Tincture of Opium.') 
The ordinary dose for an adult is twenty-five drops. A youth of 
fourteen may take fifteen drops, a child four to five years of age, 
three to five drops. Very young children do not bear well prepa- 
rations of opium, although one or two drops may be given with 
safety to a child between six months and one year of age. 

No. 50. Paregoric. {Camphorated Tincture of Opium.) 
This preparation is used more for children than adults. 
Dose for a child one month old, . . . 2 to 3 drops. 

From three months to one year, . 3 to 10 drops. 

From one to three years, . . 10 to 20 drops. 

From three to five years, . . 20 to 30 drops. 
Useful to allay pain and promote sleep. 

No. 51. Carminative Drops for Infants. 

Take of Carbonate of Magnesia, . . . .30 grains. 

Wine of Opium, 15 drops. 

Syrup of Gum Arabic, .... 3 drachms. 

Cinnamon Water, .... 5 drachms. 

Mix. Shake before using. Dose, ten drops for a child three or 

four days old. For older children the dose may be proportionately 

increased. 

Used to correct colicky pains, &c, in infants. 

No. 52. Another Form. 

Take of Carbonate of Magnesia, . 

Tincture of Assafuetida, . 

Tincture of Opium, 

Powdered White Sugar, . 

Pure Water, . 

Mix. Shake before using. Twenty-five drops may be given to 
an infant two to four weeks old, for wind colic, diarrhoea, &c 

12. ANTI-SPASMODICS. 
Anti-spasmodics are those medicines which allay spasm, and 
compose the irregular actions of the nervous system. 







30 grains. 






10 drops. 






20 drops. 






1 drachm 






1 ounce. 



342 MEDICAL AND SURGICAL COMPANION. 



No. 53. Pills of Assafoetida and Soap. 

Take of Powdered Assafoetida, .... 1 drachm. 

Powdered Castile Soap, . . . .10 grains. 
Mix well, and form into twenty pills. Two of these pills may be 
taken for a dose, and repeated once or twice a day when necessary. 
Useful in hysteria, and in colicky pains arising from wind in the 
bowels. 

No. 54. Pills of Oxalate of Cerium. 

Take of Oxalate of Cerium, .... 15 grains. 

Extract of Gentian, .... 5 grains. 

Mix, and divide into ten pills. 

Take one pill, three times a day, — one hour after each regular 
meal. 

Used to relieve the sick stomach of pregnancy. 

No. 55. Pills of Valerianate of Zinc. 

Take of Valerianate of Zinc, .... 12 grains. 

Confection of Rose, . . . .24 grains. 

Mix, and divide into twelve pills. Give one pill every three houra. 
Used in neuralgia, epilepsy, and anomalous nervous diseases. 

No. 50. Hoffman's Anodyne and Laudanum. 

Take of Hoffman's Anodyne, .... 3 drachms. 

Tincture of Opium, .... 1 drachm. 

Camphor Water, 3 ounces. 

Peppermint Water, . ... 3 ounces. 
Mix. Shake before using. 

A tablespoonful may be given every two hours, in hysteria, and 
to quiet restlessness and morbid vigilance. 

No. 57- Mixture of Cimicifuga. {Black Cohosh, — 

Black Snakeroot.) 
Take of Fluid Extract of Cimicifuga, . . . \ ounce. 
Syrup of Gum Arabic, . . . . \\ ounces. 
Syrup of Orange Peel, .... 1 ounce. 
Mix. Give a teaspoonful every three hours. The dose may be 
gradually increased to two teaspoonfuls or more. This is a remedy 
of much value in the treatment of diseases of the nervous system, 
and especially in St. Vitus' dance (chorea), and whooping-cough. 



RECIPES. PRESCRIPTIONS. MEDICINES. 343 

No. 58. Assafaitida Injection. 

Take of Tincture of Assafoetida, . . .2 drachms. 

Thin Prepared Starch, . . .4 ounces 

Mix,for an injection. It maybe given in hysteria, spasmodic colic, &c. 
One half the quantity may be safely given to a young child in 
convulsions. 

13. TONICS. 

Tonics are medicines which impart strength to the system, with- 
out subjecting it to any preternatural excitement during their 
operation. 

No. 59. Mixture of Tincture of Chloride of Iron. 

Take of Tincture of Chloride of Iron, . . 2 drachms. 
Glycerine, or Pure Water, . . 14 drachms. 

Mix. Dose, one teaspoorfful in a wineglass of water three or 
four times a day. 

Valuable as a tonic in low states of the system. Excellent in 
erysipelas ; also in chronic diarrhoea and other exhausting discharges. 

The Tincture of Chloride of Iron may be taken in simple 
water, without the glycerine, although that article very much im- 
proves the taste of the medicine, and may do good in other ways, 
especially in consumptive cases. 

No. 60. Mixture of Ammonio Citrate of Iron. 

Take of Ammonio Citrate of Iron, . . .2 drachms. 

Pure Water, 

Tincture of Quassae, . 

Tincture of Cardamon, 
Mix. Dose, a teaspoonful, in water 
Useful in chlorosis, debility, &c. 

No. 61. Tincture of Chloride of Iron and Nitric 
Acid. 

Take of Tincture of Chloride of Iron, . . 2 drachms. 

Diluted Nitric Acid, 2 drachms. 

Syrup of Ginger, . . . . 3£ ounces. 
Mix. Take a teaspoonful in a wineglassful of water three or four 
times a day. 

Good as a tonic and astringent. Often useful in consumptive 
cases accompanied by night sweats. 



. \ ounce, 
three or four times a day. 



344 MEDICAL AND SURGICAL COMPANION. 

No. 62. Wine of Iron. 

Take of Tartrate of Iron and Potassa, . . . \ ounce. 

Sherry Wine, 1 pint. 

Dissolve and filter. A good tonic. An adult may take one table- 
spoonful three times a day. Children in proportion to age. 

No. 63. Mixture of Citrate of Iron and Quinia. 

Take of Citrate of Iron and Quinia, • . .2 drachms. 

Pure Water, 3 ounces. 

Mix. Dose, one teaspoonful three times a day. It may be taken 
in a little water. An excellent tonic in most cases of debility. 

No. 64. Elixir of Pepsin. 

Take of Pepsin (Boudault), . . . . 1^ drachms. 

Pure Water, . . * . . .6-^ drachms. 

Sherry Wine, \2\ drachms. 

Alcohol, 3 drachms. 

White Sugar, 1 ounce. 

Mix thoroughly and strain. 

A tablespoonful may be taken immediately after each meal in 
cases of indigestion. Children may take from half a teaspoonful to 
a teaspoonful. 

No. 65. Tonic and Laxative Mixture. 

Take of Tincture of Colombo, .... 2 ounces. 

Compound Tincture of Gentian, . . \ ounce. 

Tincture of Rhubarb, .... 1 ounce. 

Syrup of Ginger, \ ounce. 

Mix. Dose, one to two teaspoonfula, in a little water, before 
meals, in dyspepsia, constipation, debility, &c. 

No. 66. Stimulant and Tonic. 

Take of Tincture of Peruvian Bark, ... 1 ounce. 

Tincture of Colombo, .... 1 ounce. 

Compound Tincture of Gentian, . . 1 ounce. 

Syrup of Orange Peel, . . . \ ounce. 

Syrup of Ginger, £ ounce. 

Mix. Dose, one to two teaspoonfuls in water, before meals. 
Useful in debibty, loss of appetite, dyspepsia, &c. 



RECIPES. PRESCRIPTIONS. MEDICINES. 345 

The Compound Tincture of Peruvian Baric, in one to two tea- 
spoonful doses, is a good tonic. The same may he said of the 
Compound Tincture of Gentian (Stoughton's Elixir). 

14. ALTERATIVES. 

Alteratives are medicines which reestablish the healthy func- 
tions of the animal economy, without producing any active evacua- 
tion. 

No. 67. Mixture of Iodide of Potassium and Sarsa- 
parilla. 

Take of Iodide of Potassium, .... 8 scruples. 
Compound Syrup of Sarsaparilla, . . 3^- ounces. 
Fluid Extract of Stillingia, . . . -J ounce. 
Mix. Dose, a teaspoonful three times daily, after meals. It 
should be taken in about a wineglassful of water. 

This is an excellent preparation, and may be used in scrofula, 
secondary syphilis, and obstinate skin diseases. It can be given 
advantageously in most cases requiring an alterative. 

No. 68. Syrup of Iodide of Iron. 

Dose, ten to twenty drops, in water, three times a day. This is 
a good alterative and tonic in scrofulous affections, accompanied 
with debility. 

No. 69. Pills of Protoiodide of Mercury. 

Take of Protoiodide of Mercury, ... 24 grains. 

Powdered Extract of Licorice, . . 48 grains. 
Mix, and divide into twenty-four pills. Take one, three times a 
day, in syphilis. 

No. 70. Cod-Liver Oil. 

Dose, for an adult, one tablespoonful, three times a day, one hour 
after each regular meal. Children may take from one to two tea- 
spoonfuls. It may be taken with a little porter, ale, milk, wine, 
whiskey, or brandy, according to preference. I often order it with 
sherry wine, giving about four times as much wine as oil. If the taste 
is objectionable, three or four drops of some essence may be added to 
each dose, and a few mint drops allowed to dissolve in the mouth 
after taking it. 



346 MEDICAL AND SURGICAL COMPANION. 

This oil is very beneficial in the early stages of pulmonary con- 
sumption, also in scrofulous affections, and in general debility 
arising from poor blood. Good substantial food should at the 
same time be taken. 

15. ASTRINGENTS. 

Astringents are such substances as, applied to the human body, 
produce contraction and condensation of the soft solids, and 
thereby increase their density and force of cohesion. 

No. 71. Pills of Tannin and Opium. 

Take of Tannic Acid, 20 grains. 

Powdered Opium, .... 5 grains. 
Glycerine, a sufficient quantity to form a pill mass ; then divide 
into ten pills. One may be taken every two or three hours, in 
diarrhoea, after the bowels have been thoroughly moved by rhubarb 
or castor oil. 

No. 72. Powders of Gallic Acid. 

Take of Gallic Acid, 2 drachms. 

Powdered Opium, .... 6 grains. 
Mix, and divide into twelve powders. Take one powder in mo- 
lasses, or sugar and water, every three hours. 

Useful in bleeding from the lungs, kidneys, and uterus. 

No. 73. Compound Mixture of Hardhach. 

Take of Fluid Extract of Hardhack, . . \ ounce. 

Compound Spirit of Lavender, . . \ ounce. 

Syrup of Gum Arabic, . . .1 ounce. 

Mix. Dose for a child, from half a teaspoonful to a teaspoonful 
three or four times a day, in diarrhoea. 

No. 74:. Mixture of HardhacTc, Catechu, Lauda- 
num, <&c 

Take of Fluid Extract of Hardhack, . . .1 ounce. 

Tincture of Catechu 1 ounce. 

Brandy, . . . ' . . .1 ounce. 

Laudanum, 1 ounce. 

Mix. Dose for an adult, one teaspoonful. It may be taken every 
three or four hours, if necessary, in diarrhoea, after the bowels have 
been moved by some cathartic, as rhubarb, castor-oil, or Epsom 
salts. 



RECIPES. PRESCRIPTIONS. MEDICINES. 347 

No. 75. Astringents for External Use. 

Tannin, powdered matico leaves, alum, &c, are often useful to 
check bleeding from superficial wounds. 

In bleeding from the nose, they may be used in solution, or the 
dry powder may be used as snuff. 

16. ANTACIDS. 

Antacids are remedies for correcting acidity in the stomach and 
bowels. Bicarbonate of Soda, Saleratus, and Carbonate of Mag- 
nesia are good antacids. Fluid Magnesia is excellent. If the 
patient is dyspeptic, appropriate tonics and regulation of the diet 
will be required. 

No. 76. Bicarbonate of Soda. 

Dissolve from half a teaspoonful to a teaspoonful in a tumblerful 
of water, and drink as occasion requires, in acidity of the stomach, 
or " heartburn." 

No. 77. Powder of Magnesia and Colombo. 

Take of Calcined Magnesia, . . . . \\ drachms. 
Powdered Colombo, .... 1 drachm. 
Powdered Ginger, . . . .10 grains. 

Mix, and divide into ten powders. One may be taken three 
times a day in sugar and water. Useful in acidity of the stomach. 

17. CAUSTICS. 

No. 78. Lunar Caustic. {Nitrate of Silver.) 
This is often useful when passed lightly over old ulcers or sores. 

It stimulates them to take on a healthy or healing action. 

When used as a caustic, it should be pressed against the surface 

for a few seconds. 
Burnt Alum. — This may be applied in powder to fungous 

granulations — " proud flesh " — of ulcers. 

No. 79. Nitric Acid. 

This is a very ' powerful caustic, and must be used with great 
caution. To destroy a venereal ulcer, or chancre, dip a glass rod, 
or a piece of wood, shaped like a pen-handle, into the acid, and 



348 MEDICAL AND SURGICAL COMPANION. 

pass it over the whole surface to be destroyed. Let it remain on a 
moment, and then wash off with pure water. It is quite painful 
while on, but soon after being washed off the pain ceases. Some 
soothing and astringent wash may be used, two or three times a 
day, after the caustic has been applied. 

18. EPISPASTICS. BLISTERS. 

Epispastics are those articles which produce a serous or watery 
discharge beneath the cuticle, — the blister of common language. 

No. 80. Blistering Plaster. 

This may be made by spreading blistering ointment on leather, 
cloth, or adhesive plaster. It may be of any size required, from 
one to six or eight inches square. It should remain on the part 
until a good blister has formed ; then remove it, and dress the 
blister with simple ointment, or sweet oil. This is sometimes 
termed a " Fly-blister," the active ingredient being cantharides, — 
Spanish flies. 

Aqua AMMONIA, Mustard, and some other articles will " blister," 
but the ordinary fly-Mister is preferable in most cases. 

19. RUBEFACIENTS. 

Rubefacients are substances which irritate, and sometimes blis- 
ter, on very delicate skins, especially if kept long on the part. 

No. 81. Mustard Plaster. 

Take of Powdered Black Mustard, . . .1 ounce. 
"Water, sufficient to make a paste or poultice. 

The uses of the mustard plaster are too well known to require 
description. It is sometimes made by adding an equal quantity of 
flaxseed or Indian meal ; this should always be done for children, 
or persons of delicate skins. It should be kept on as long as it 
can be borne, which will not generally be longer than half an hour. 

No. 82. Crround BlacJc Pepper. 

If mustard is not at hand, this may be taken as a substitute. 

No. 83. Onion Poultice. 

Onions are often used in cases of croup, and in diseases of the 
chest in children, as revulsives and antispasmodics. 



RECIPES. PRESCRIPTIONS. MEDICINES. 349 

Having been partially roasted, mashed, and. spread between the 
folds of thin muslin, they may be applied over the chest, and per- 
mitted to remain as long as they retain their warmth and moisture. 

No. 84L. Volatile Liniment. 

Take of Olive Oil, 2 ounces. 

"Water of Ammonia, .... 1 ounce. 

Mix. This may be used for sprains, bruises, enlarged glands, 
&c. It is also beneficially applied to the neck, in inflammatory 
troubles of the throat, croup, &c. 

No. 85. Croton Oil Liniment. 

Take of Croton Oil, 1 drachm. 

Olive Oil, 3 drachms. 

Mix. Croton oil' is one of our safest and most efficient rubefa- 
cients. It should be rubbed very lightly upon the part, morning 
and night, until a crop of pimples begin to appear ; then discontin- 
ued for a time. Two rubbings will generally be sufficient. When 
the little vesicles begin to dry up, re-apply it if necessary. 

No. 86. Lodine Paint. (Tincture of Iodine.) 
This may be well rubbed over the part, once or twice a day, by 
means of a camel's-hair brush. Useful when applied to glandular 
swellings, inflamed or enlarged joints, &c. 

20. EYE WASHES. 

No. 87. Sulphate of Zinc Eye Wash. 

Take of Sulphate of Zinc 2 grains. 

Hose Water 1 ounce. 

Mix. Drop a little into the eye, two or three times a day, when 
sore or inflamed. 

No. 88. Acetate of Zinc Eye Wash. 

Take of Acetate of Zinc, 2 grains. 

Rose Water, 1 ounce. 

Mix. Use three or four times a day, for sore eyes. 

No. 89. Sugar of Lead Eye Wash. 

Take of Sugar of Lead, 2 grains. 

Rose Water, 1 ounce. 

Mix. Excellent for inflamed eyes. It should be used two or 
three times a day. 



350 MEDICAL AND SURGICAL COMPANION. 

No. 90. Nitrate of Silver Eye Wash. 

Take of Nitrate of Silver (crystals), ... 1 grain. 

Distilled Water, 1 ounce. 

Mix. Use by dropping a little into the eye twice a day, in acute 
inflammation, or to cause specks to disappear. 

21. WASHES, &c. 

FOR THE EAR. 

No. 91. Goulard's Extract and Rose Water. 

Take of Goulard's Extract (Liquid Subacetate of 

Lead), ^ drachm. 

Glycerine, 1 drachm. 

Rose Water, . . . : . . 2 ounces. 

Mix. This may be dropped into the ear, until the cavity is full, 

and be allowed to remain there for a few minutes. Use morning 
and night. For running from the ear. 

No. 92. Solution of Nitrate of Silver. 

Take of Nitrate of Silver, 10 grains. 

Distilled Water, . . . ... 1 ounce. 

Mix. Used in ulceration, attended by discharges of matter (pus) 
from the ear. Dip a camel's-hair brush into the solution, and apply 
every second or third day. Between the applications use R. 91. 

No. 93. Borax and Glycerine Injection. 

Take of Powdered Borax, 5 grains. 

Glycerine, 2 drachms. 

Rose Water,. 6 drachms. 

Mix. Useful in checking discharges from the ear. Use morning 
and night. First " syringe " the ear with simple warm water, then 
throw in a little of this preparation. 

22. INJECTIONS. 

FOR THE URETHRA. 

When injections are employed in the cure of gonorrhoea, two 
circumstances merit especial attention, viz. : the manner of injecting 
them, and the frequency of using them. The hard-rubber penis 
syringe is to be preferred, but a glass one, with a smooth point, will 
answer. The patient should oil the pipe before using it, seat him- 



RECIPES. PRESCRIPTIONS. MEDICINES. 351 

self on the edge of a bed or chair, draw the penis upward on the 
syringe with the left hand, and with the other throw the injection 
to the seat of the disease. With regard to the frequency of inject- 
ing, I will say that weak injections should be used from three to six 
times a day ; strong ones, once or twice. 

In using ordinary injections, such as sulphate or acetate of zinc, 
of medium strength, three or four times a day will answer. 

No. 94. Nitrate of Silver. 

This article is much used both in gonorrhoea and gleet. Some 
practitioners employ a weak solution of two grains to eight ounces 
of water, and use it three or four times a day ; others prefer two or 
three grains to the ounce, and use it once or twice a day. I prefer 
the weaker solution. 

No. 95. Injections of Sulphate of Zinc and Lau- 
danum. 

Take of Sulphate of Zinc, 10 grains. 

Powdered Gum Arabic, . . . .20 grains. 

Laudanum, 2 drachms. 

Pure Water, 8 ounces. 

Mix. Excellent in gonorrhoea and gleet. Use three or four times 
a day. 

No. 96. Injection of Acetate of Zinc. 
Take of Acetate of Zinc, 8 grains. 

Rose Water, 4 ounces. 

Mix. Inject three times a day, in gonorrhoea and gleet. 

No. 97. Injection of Chloride of Zinc 

Take of Chloride of Zinc, 4 grains. 

Water, 4 ounces. 

Mix. Use as an injection, two or three times a day, in gonorrhoea 
and gleet. 

23. VAGINAL INJECTIONS. 

No. 98. Injection of Chloride of Soda. 

Take of Solution of Chloride of Soda, . . . 1 ounce. 

Water 9 ounces. 

Mix. A cleansing and antiseptic injection, to be used two or 
three times a day, when required. 



352 MEDICAL AND SURGICAL COMPANION. 

No. 99. Injection of Sulphate of Zinc. 

Take of Sulphate of Zinc, 1 drachm. 

Water 1 pint. 

Mix. Use, with a proper female syringe, three times a day, in 
leucorrhoea and gonorrhoea. The injection should be taken when 
lying down, with the hips raised, so that, it may be retained ten or 
fifteen minutes, for if it passes away immediately, little good will 
be derived from it. 

No. 100. Injection of Sugar of Lead. 

Take of Sugar of Lead, 1 drachm. 

Water, 1 pint. 

Mix. Useful in leucorrhoea and gonorrhoea. Should be used 
three times a day. 

No. 101. Injection of Nitrate of Silver. 

Take of Nitrate of Silver, 30 grains. 

Distilled or Pure Water, . . .1 pint. 

Mix. Use morning and night, in leucorrhoea and gonorrhoea. 

24. GARGLES AND MOUTH WASHES. 

No. 102. Gargle of Borax and My rrha. 

Take of Powdered Borax 1 drachm. 

Tincture of Myrrha, \ ounce. 

Pure Honey, 1 ounce. 

Rose Water, or Pure Water, . . .4 ounces. 
Mix. An excellent gargle for sore mouth, scorbutic affections of 
the gums, &c. Use three or four times a day. 

No. 103. Gargle of Sulphate of Zinc 

Take of Sulphate of Zinc, . . . . 30 to 60 grains. 

Water, 1 pint. 

Mix. Use three or four times a day. Excellent in many cases of 
sore throat, where a stimulating and astringent gargle is required. 

No. 104. Gargle of Alum. 

Take of Powdered Alum, . .... 2 drachms. 

Water, £ pint. 

Mix. Useful in sore mouth, inflammation of the tonsils, &c. 



RECIPES. PRESCRIPTIONS. MEDICINES. 353 

No. 105. Gargle of Alum, Sage Tea, and Money. 

Take of Sage, \ ounce. 

Boiling "Water -J pint. 

Make an infusion or tea, and strain ; then add 

Powdered Alum, \ ounce. 

Honey, 1 ounce. 

Mix and shake well. This domestic remedy is very effectual in 
cases of sore throat. 

No. 106. Chlorate of Potassa Gargle. 

Take of Powdered Chlorate of Potassa, . . 2 drachms. 

Pure Water, 4 ounces. 

Mix. A very useful gargle in sore throat, diphtheria, aphthae, or 
thrush, &c. Use three to six times a day. 

SOLUTION OF SULPHITE OF SODA. 

Take of Sulphite (not Sulphate) of Soda, . . 1 drachm. 

Rose "Water, 1 ounce. 

Mix. To be applied, with a camel's-hair brush, to sore mouth, 
aphtha;, &c. Use three or four times a day. This is generally pref- 
erable to the chlorate of potassa gargle, for the eore mouths of in- 
fants. 

No. 107. Lotion of Muriatic Acid. 
Take of Muriatic (Hydrochloric) Acid, . . ■£ drachm. 

Pure Honey, 1 ounce. 

Rose Water, 1 ounce. 

Mix. To be applied, three times a day, with a camel's-hair brush, 
to scorbutic gums, or ulcers about the mouth. 

25. LINIMENTS, WASHES, &c. 

No. 108. Opium Liniment. 

This is an excellent liniment to be applied to painful parts, rheu- 
matic joints, sprains, bruises, &c. Use three or four times a day. 

No. 109. Soap Liniment. {Opodeldoc.') 
A liniment much used in rheumatism, sprains, &c. To be applied 
several times a day. 

No. 110. Volatile Liniment. 

A good liniment for chronic rheumatic pains, sprains, sore throat, 
&c. Use three times a day. 
23 



354 MEDICAL AND SURGICAL COMPANION. 

No. 111. Chloroform Liniment. 

Take of Chloroform, 1 ounce. 

Sulphuric Ether, 1 ounce. 

Spirit of Camphor, .... 1 ounce. 

Tincture of Opium, .... 1 ounce. 
Mix. Use three times a day. Excellent for rheumatic pains, 
sprains, &c. 

No. 112. Black Wash. 
Take of Calomel, 1 drachm. 

Lime Water, ■£ pint. 

Mix. A good application to venereal sores, chancres, &c. 

No. 113. Lotion of Borax and Glycerine. 

Take of Powdered Borax, . . . .30 grains. 

Glycerine, 1 ounce. 

Rose Water, 5 ounces. 

Mix. Used for chapped hands, fissures of the lips, sore nipples, 
and irritation of the skin of any kind. 

No. 114. Glycerine Lotion. 

Take of Glycerine, 1 ounce. 

Rose Water 1 ounce. 

Mix. This is an emollient and soothing lotion, useful in chaps, 
excoriations, eczema, and scaly affections of the skin. 

No. 115. Lotion of Tannin and Glycerine. 

Take of Tannic Acid 2 drachms. 

Glycerine, 1 ounce. 

Mix. Excellent for sore nipples, bed sores, piles, &c. It may 
be applied two or three times a day. 

No. 116. Lotion of Ammonia, Glycerine, <£c. 

Take of Aromatic Spirits of Ammonia, . . \ ounce. 

Glycerine, 1£ ounces. 

Tincture of Spanish Flies, . . .3 drachms. 
Water of Rosemary, .... 6 ounces. 
Mix. Used for falling off of the hair, dryness or want of action 
of the 6calp, thinness of the hair, &c. Apply with a hair brush 
once or twice a day. 



RECIPES. PRESCRIPTIONS. MEDICINES. 355 

No. 117. Lotion of Carbolic Acid and Glycerine. 

Take of Carbolic Acid (Crystals), . . .2 drachms. 

Glycerine, 1 ounce. 

Hose Water, 1 ounce. 

Mix. Useful when applied to foul ulcers, sores, wounds, and in 
some forms of skin diseases. Apply twice a day. 

No. 118. Another. 

Take of Carbolic acid (Crystals), . . .2 drachms. 

Boiled Linseed Oil, .... 2 ounces. 
Mix. Useful in the same cases as the above. To be applied two 
or three times a day. 

26. OINTMENTS. 

No. 119. Simple Ointment. 

Take of Fresh Lard, 3 ounces. 

White Wax, . . . 1 or 2 ounces. 

Oil of Sweet Almonds, .... 1 ounce. 
Melt together, and stir until cool. If for winter use, one ounce of 
white wax will be sufficient, but if for warm weather, use two 
ounces. A few drops of oil of rose, added when nearly cool, will 
give it a fine odor, but this is not essential. 

Useful in dressing wounds, burns, scalds, blisters, cuts, and sores 
of almost every description. 

No. 120. JResin Ointment. (Basilicon Ointment.') 

Take of Powdered Resin, 1 ounce. 

Yellow Wax, \ ounce. 

Fresh Lard, or Simple Ointment, . . 2 ounces. 
Melt with a gentle heat, strain through flannel, and stir constant- 
ly until cool. 

Useful in dressing indolent ulcers, sores, wounds, &c, where some- 
thing more stimulating and adhesive than simple ointment is re- 
quired. 

No. 121. Compound Sulphur Ointment. 

This can be bought at the apothecaries. Used for diseases of the 
skin — itch, ringworm, &c. 



356 MEDICAL AND SURGICAL COMPANION. 

No. 122. Simple Sulphur Ointment. 

Take of Lac Sulphur, \ pound. 

Fresh Lard, 1 pound. 

Oil of Bergamot, 2 drachms. 

Mix well. Used in itch. 

In making simple sulphur ointment, the sublimed sulphur is gen- 
erally used, but I prefer the precipitated or lac sulphur. 

No. 123. Benzoated Ointment of Oxide of Zinc. 

This can be obtained of apothecaries. A mild astringent appli- 
cation for ulcers, wounds, excoriations, burns, &c. 

No. 124. Ointment of Tar and Citrine Ointment. 

Take of Tar Ointment, 1 ounce. 

Citrine Ointment, . ^ ounce. 

Mix. Useful in tinea capitis — scald head, &c. 

No. 125. Ointment of Tannate of Lead. 

Take of Tannate of Lead 1 drachm. 

Glycerine 2 drachms. 

Simple Ointment, 1 ounce. 

Mix. A sedative and astringent application for sore nipples, 
chapped surfaces, bed sores, &c. 

27. POULTICES. (Cataplasms.) 

No. 126. Flaxseed- Meal Poultice. 

Take of flaxseed meal, a sufficient quantity. Pour boiling water 
upon it, and stir constantly until the poultice has a soft, pulpy con- 
sistence. This may be used with advantage in almost all cases 
requiring a poultice. If the part to which it is to be applied is 
painful, the surface of the poultice may be wet with laudanum. To 
prevent it from drying too soon, it may be covered with a little pure 
sweet oil. 

No. 127. Bread and MilJc Poultice. 

Take the soft part of a portion of a loaf of stale bread, crumble 
it into a bowl or dish, and add milk to cover it. Simmer over a 
fire, occasionally stirring, until the bread is reduced to a pulpy con- 
sistence. The poultice may be applied as warm as the patient can 
bear it. This is a good poultice, and may be used when flaxseed 
meal is not at hand. If milk be not at hand, use water instead. 



EECIPES. PRESCRIPTIONS. MEDICINES. 357 

No. 128. Slippery-Elm Poultice. 

Take of powdered or ground slippery-elm bark, a sufficient quan- 
tity. Moisten with hot water until it becomes a soft, pulpy mass. 
Apply warm. Used for the same purposes as the flaxseed poultice. 

No. 129. Water Dressings. 

Water Dressings may be either cold or warm, simple or med- 
icated. Lint, or any soft absorbent fabric may be used for the pur- 
pose of maintaining the liquid in contact with the part. 

No. 130. Cold Water acts by depressing the vital force of the 
parts. It should be as cold as the patient can bear it with comfort, 
and needs renewal as often as the temperature rises, by the abstrac- 
tion of heat from the part. Ice-water is an excellent application in 
many cases, especially to wounds of the head, wounds of joints, &c. 
A very good plan is to place old linen rags, soaked in ice-water, 
upon the part, and then to lay one or more small lumps of ice, 
folded up in another wet rag, upon the top ; in this way the tem- 
perature may be kept down, and excessive inflammation prevented. 

Astringents, anodynes, and refrigerants, — such as tannin, sugar 
of lead, laudanum, &c, — may be combined with cold water. 

No. 131. Warm Water has of itself a soothing and relaxing 
influence, upon any part to which it may be applied. Lint, flannel, 
or woollen rags may be used as a vehicle for it ; and as any evapo- 
ration would lower its temperature, a piece of oiled silk, or of India- 
rubber cloth, if at hand, should be placed over it. Some surgeons 
discard the poultice entirely, preferring to use warm water ; but, in 
fact, there is often a good deal of room for choice between the two. 

Warm water is much more frequently medicated than cold, prin- 
cipally because it requires less constant renewal. Astringents, such 
as sulphate of zinc, sugar of lead, tannin, &c, may be dissolved in 
it. Deodorants — chloride of soda, permanganate of potassa, &c, 
— may be added to it, in greater or less proportion, for the dressing 
of offensive sores, bad-smelling feet, &c. 

28. BATHS, &c. 

No. 132. The Cold Bath. 

A cold or cool bath, once or twice a week, is beneficial for persons 
in health. A wash-bowl of water, soap, sponge, and coarse towel, 
are all the articles required in taking it. Rub the whole surface of 



358 MEDICAL AND SURGICAL COMPANION. 

the body well, with the sponge, saturated with the soap and water, 
after which, rub the whole body briskly with the coarse towel, until 
dry. 

No. 133. Warm BatJi. 
Have the water of such a temperature as to feel warm to the hand. 
In cases where the health is poor, and little or no reaction follows 
he use of the cold bath, this may be substituted. 

No. 134. Alkaline Bath. 

Take of Bicarbonate of Soda, or Saleratus, . 1 ounce. 

"Water, warm or cool, .... 2 quarts. 
Mix. Useful in fevers, itching of the skin, &c. 

FOMENTATIONS. 

Fomentations, used warm, or hot, are good counter-irri- 
tants. They may be made by dipping a piece of flannel, folded 
several times, in warm or hot. water, allowing it to remain three to 
five minutes, and then wringing it nearly dry. It should be of suf- 
ficient size to well cover the part to which it is applied. A piece 
of oiled silk or a dry cloth may be placed over it, to prevent evapo- 
ration. Fomentations should generally be about as hot as the pa- 
tient can bear, where active counter-irritation is indicated, and must 
be renewed every ten or fifteen minutes. In pleurisy, congestion of 
the lungs, lung fever, and inflammation of the bowels, oil of tur- 
pentine may be gently applied to the parts, before applying the hot 
cloths ; or it may be sprinkled upon them. 

29. MISCELLANEOUS RECIPES. 

No. 135. Tooth-Ache Drops. 

Take of Mastic, 1 drachm. 

Chloroform 1 ounce. 

Mix. Moisten with the solution cotton enough to fill the cavity 
of the tooth, and press it well in. 

No. 136. Another. 

Take of Oil of Cloves, 1 drachm. 

Chloroform, 1 drachm. 

Mix. Use as directed above. Oil of cloves alone is excellent. 






RECIPES. PRESCRIPTIONS. MEDICINES. 359 

No. 137. Another. 

Take of Gum Camphor, ^ ounce. 

Strongest Alcohol, .... 1 ounce. 

Mix in a mortar, and rub until the camphor is dissolved. Use 
as above. 

No. 138. Tooth Powder. 

Take of Prepared Chalk, 1 ounce. 

Powdered Orris Eoot, .... 1 ounce. 
Powdered Castile Soap, . . .2 drachms. 

Mix. Use after breakfast and supper. 



No. 139. Another 

Take of Powdered Orris Root, . 
Powdered Peruvian Bark, 
Powdered Gum Myrrha, 
Powdered Cinnamon Bark, 
Bicarbonate of Soda, 

Mix. Use as above. 



1 ounce. 
1 drachm. 
\ drachm. 
1 drachm. 
1^ drachms. 



30. PREPARATIONS FOR THE HAIR. 

No. 140. Hair Oil. 

Take of Castor Oil, . . . . . .2 ounces. 

Glycerine, 2 drachms. 

Cologne Spirit, 2 ounces. 

Oil of Bergamot, 1 drachm. 

Oil of Rose, 4 drops. 

Mix. 

No. 141. Another. 
Take of Olive or Castor Oil, . . . .3^ ounces. 

Glycerine, 2 drachms. 

Oil of Jessamine, 1 drachm. 

Oil of Orange, 1 drachm. 

Mix. 

No. 142. Hair Restorative. 

Take of Sugar of Lead, \ drachm. 

Lac Sulphur, 1 ^rachm. 

Glycerine, 3 drachms. 

Rose Water, 3^ ounces. 

Mix. To be applied to the scalp with a brush, once or twice a 
day. 



360 



MEDICAL AND SURGICAL COMPANION. 



No. 143. Another. 

Take of Aromatic Spirit of Ammonia, . . 2 drachms. 
Tincture of Cantharides, . . .2 drachms. 

Glycerine, \ ounce. 

Rose Water, 3 ounces. 

Mix. Use twice a day , and rub well into the scalp with a brush. 
Excellent for baldness and falling off of the hair. 



No. 144. 

Take of Oil of Verbena, . 

Oil of Citronella, . 

Oil of Bergamot, . 

Cologne Spirit, 
Mix. 

No. 145. 
Take of Oil of Jessamine, 

Oil of Neroli, 

Oil of Lemon, 

Oil of Bergamot, . 

Oil of Rose, 

Cologne Spirit, 



Cologne 



Another 



Mix. 



1 drachm. 


1 drachm 


1 drachm 


1 pint. 


1 drachm. 


\ drachm. 


\ drachm. 


1 drachm. 


16 drops. 


1 pint. 



ADDITIONAL MEDICINES. 



No. 146. Quinine Mixture. 

Take of Sulphate of Quinia, . . . .32 grains. 
Aromatic Sulphuric Acid, . . .1 drachm. 

Pure Water, 2 ounces. 

Mix. A good tonic, in doses of one teaspoonful, three times a 
day. As an anti-periodic, in intermittent fever, it may be given in 
teaspoonful doses every hour, commencing six hours before the ex- 
pected paroxysm or chill. Give in a little water. 

No. 147. Solution of Tannin. 

Take of Tannic Acid, 1 drachm. 

Water, 1 pint. 

Mix. This may Be used two or three times a day, as a vaginal 
injection, in profuse menstruation, leucorrhoea, &c. The strength of 
the solution may be increased every day or two, if necessary, by 
adding more tannin to the water. 



RECIPES. PRESCRIPTIONS. MEDICINES. 361 

No. 148. Nitro- Muriatic Acid Mixture. 

Take of Diluted Nitro-Muriatic Acid, . . \ ounce. 

Pure Water, 11 ounces. 

Simple Syrup, 2 ounces. 

Mix. An adult may take one teaspoonful, in a wineglass of water, 
three times a day. An excellent remedy in some chronic affections 
of the liver. It is also useful in some forms of syphilitic disease. 

No. 149. Compound Rhubarb Pills. 

Take of Powdered Rhubarb, .... 1 ounce. 

Powdered Socotrine Aloes, . . .6 drachms. 
Powdered Myrrha, . . \ ounce. 

Oil of Peppermint, . • • \ ^ u ^ tbrm. 

Mix thoroughly, adding a little water to form a pill mass ; to be 
divided into two hundred and forty pills. This is a warm tonic 
laxative, useful in costiveness with debility of the stomach. From 
two to four pills, or from ten to twenty grains of the mass, may be 
taken twice a day. 

No. ISO. Mixture of Green Iodide of Mercury and 
Iodide of Potassium. 

Take of Green Iodide of Mercury, . . .3 grains. 

Iodide of Potassium, .... 2 drachms. 
Compound Tincture of Gentian, . . 2 ounces. 
Compound Syrup of Sarsaparilla, . . 2 ounces. 
Mix. Take a teaspoonful three times a day, in a wineglass of 
water, after meals. An excellent remedy in syphilis, primary and 
secondary, and various skin diseases, as well as an excellent altera- 
tive in follicular laryngitis, and ulcerations of the epiglottis. 

No. 151. Blue Pill. Mercurial Pill. 

This is supposed to exert a decided influence over the liver, by 
increasing the flow of bile. In affections of the liver, such as tor- 
pidity, or want of proper action in that organ, a three to five grain 
pill may be taken with much advantage, once or twice a week, at 
bedtime, followed by a Rochelle powder, or dose of castor-oil, in the 
morning. This pill should never be used except when really indi- 
cated. 

No. 152. Calomel. 

This is considered one of the most efficient and valuable prepa- 
rations of mercury, but requires to be used with much caution and 



. 6 grams. 


. 12 grains. 


. 48 grains. 


. 6 grains. 


. 4 drops. 



6b2 MEDICAL AND SURGICAL COMPANION. 

judgment. In skilful hands, it is adapted to cure or relieve some of 
the most formidable diseases.. In this work, I have occasionally 
recommended its employment, but cannot advise non-medical per- 
sons to make much use of it. 

The following pills may be used to advantage, as a substitute for 
mercurials, in some complaints usually denominated " bilious." 

Xo. 153. 

Take of Podophyllin, 
Leptandrin, 

Compound Extract of Colocynth, 
Extract of Belladonna, 
Oil of Peppermint, 
Mix, and divide into twenty-four pills. 
Dose, for an adult, as a cathartic, one to three ; as an alterative, 
one every night, or every second night, according to the effect pro- 
duced. 

Xo. 154. Composition Powder. 
Take of Powdered Bayberry Bark, . . .4 ounces. 
Powdered Ginger, 
Powdered Cayenne Pepper, 
Powdered Cloves, 
Powdered Cinnamon Bark, 
Mix. Dose, for an adult, one teaspoonful. It should be steeped 
for half an hour, in a teacupful of boiling water, and drank warm. 
The feet should at the same time be well soaked in warm water. 
Useful for chilliness, after exposure to cold. 

No. 155. Hot Drops. 

Take of Cayenne Pepper, . \ ounce. 

Gum Myrrh, 1 ounce. 

Alcohol, or Brandy 1 quart. 

Mix. Let it stand one to two weeks, then strain or filter through 
paper. Dose, for an adult, from half a teaspoonful to a teaspoonful. 
It may be taken in a little water. Used for griping pains in the 
bowels, arising from wind, &c. It is also used externally, as a lini- 
ment, for chronic rheumatic pains. The " composition powder " and 
the " hot drops " are known as Thompsonian medicines. 

Xo. 156. Chalk Mixture. 

This mixture, which is to be found in all apothecary stores, is 
much used in the diarrhoea of children. The dose for a child a year 



. 6 ounces. 

. \ ounce. 

. 2 drachms. 

. 2 drachms. 



KECIPES. PRESCRIPTIONS. MEDICINES. 



363 



or two old is about a teaspoonful, and may be repeated two or tbree 
times a day. 

No. 157. Diarrhoea Mixture. 

Take of Chalk Mixture, 3\ ounces. 

Tincture of Catechu, .... 3 drachms. 

Laudanum, 1 drachm. 

Mix. Dose, for an adult, one tablespoonful : to be repeated three 
or four times a day. Children may take from half a teaspoonful to 
a teaspoonful or two, according to age. 



No. 158. Another 

Take of Lime Water, 

Fluid Extract of* Hardhack, . 
Mucilage of Gum Arabic, 
Laudanum, .... 

Mix. Dose, for an adult, one tablespoonful 



. 2 ounces. 
. 1 ounce. 
. 6 drachms. 
. 2 drachms, 
for children, one half 



teaspoonful to a teaspoonful. 
times a day. 



It may be repeated three or four 






No. 159. Ointment of Iodide of Sulphur. 

Take of Iodide of Sulphur, \ drachm. 

Lard, 1 Troy ounce. 

Rub the iodide of sulphur, first reduced to a fine powder, with 
a little of the lard, then add the remainder and thoroughly mix 
them. 

This is an excellent local remedy for skin diseases, unattended 
with inflammation ; and is especially useful in psoriasis, lepra, por- 
rigo, and the very advanced stages of eczema and impetigo, when 
they have become dry. 

No. 160. Ointment of Iodide of Lead. 

Take of Iodide of Lead, 1 drachm. 

Lard, 1 ounce. 

Rub them together until thoroughly mixed. Useful as a discu- 
tient in chronic glandular swellings, enlargements of joints, &c. 

No. 161. American Hellebore (Vcratrum Viride.) 

This is an arterial sedative, and is used by many physicians in 

fevers and inflammations, characterized by a rapid, full, and hard 

pulse. The tincture is the preparation generally employed. The 

commencing dose should not exceed eight or ten drops. It may be 



364 MEDICAL AND SURGICAL COMPANION. 

repeated every third hour, until the force and frequency of the pulse 
have become reduced to nearly the healthy standard. If too large 
doses are given, or a small one too frequently repeated, nausea and 
vomiting may be induced. In acute rheumatism, pleurisy, the Jirst 
stage of lung fever, and in inflammatory fever, this medicine, when 
administered, and its effect upon the pulse and disease carefully 
watched by a skilful physician, may do much good. Non-medical 
persons are not qualified to use it to much advantage. 

ANESTHETICS. 

No. 162. Sulphuric Ether, Chloroform, and 
Nitrous Oxide. 

These agents, in the form of vapors, administered by inhalation, 
are used to produce general anaesthesia, or insensibility to pain 
during surgical operations. 

Chloroform is little used in this cpuntry, being more danger- 
ous than ether, many cases of death from its use having occurred. 
It has been administered internally, in doses of thirty to sixty drops, 
suspended in mucilage of gum arabic, in some cases of colic, sea- 
sickness, &c, with apparent benefit. 

The Nitrous Oxide, for short surgical operations, as the extrac- 
tion of teeth, &c, is now considered safe and reliable. It is much 
used by dentists. 

Sulphuric Ether is the agent chiefly used in this country, es- 
pecially for long and severe surgical operations, and other cases 
where it is advisable to keep the patient in a state of insensibility 
for some hours, as in puerperal convulsions, &c. Its effects, when 
inhaled, are, first exhilaration, then violent excitement, and finally 
complete insensibility. About two fluid ounces will generally be 
required for an adult, but some persons are more susceptible to it 
than others, and much more, of course, will be given if the insensi- 
bility is kept up for a length of time. Nausea and vomiting of 
whatever may be in the stomach, are usually observed as the patient 
revives. Consciousness is soon recovered, but there is, for several 
hours, a state of more or less mental confusion, and an odor of ether 
may be perceived in the breath for several days. Altogether, the 
symptoms are much like those of alcoholic intoxication, but are less 
lasting, and pass in quicker succession. Nor is there so great a 
degree of ensuing depression ; headache also is infrequent after the 



RECIPES. PRESCRIPTIONS. MEDICINES. 365 

inhalation of ether. No case of death from the moderate use of 
this agent is on record. It is inflammable, and should not be ad- 
ministered anywhere near a lamp, candle, or gas light. 

MODE OF ADMINISTRATION. 

Sulphuric ether is usually poured into the hollow of a cone-shaped 
sponge, previously wrung out of water. To prevent waste by evap- 
oration, a towel is placed over the sponge. It is desirable to have 
as little air as possible mixed with the inhaled ether. The person 
administering it should stand behind the patient's head, grasping it 
between his open hands, and steadying the 6ponge — applied over 
the nose and mouth — between his thumbs and fore-fingers ; thus, 
after the first gradual approach of the sponge, making it next to im- 
possible for the patient to get his face away from it, and at the 
same time avoiding all risk of squeezing the sponge and wasting 
the ether. At the same time it is advisable to urge the patient to 
blow through the sponge, in order to obtain the succeeding deep 
inspiration. Complete etherization is indicated by total loss of vol- 
untary motion, relaxation of the muscles of the extremities, and 
absence of pain when the conjunctiva is touched. A patient may 
be safely kept under its influence so long as the breathing is not 
stertorous ; the sponge may be withdrawn, at short intervals, and 
reapplied so long as it may be necessary to keep the patient in a 
gentle slumber. Neither of these agents should be administered to 
any one laboring under serious organic disease of the brain, heart, 
or lungs, especially the two former. No non-medical person should 
attempt to etherize a patient, when a physician can be readily ob- 
tained. 



THE MEDICATED VAPOR INHALER. 

This is used for the inhalation of medicated vapors, in the treat- 
ment of chronic bronchitis, asthma, and consumption. Price, $1. 



THE NASO-PHARYNGEAL SYRINGE. 

This is a shower syringe, with extra long silver tube, curved at 
the end, so as to readily pass into the posterior nasal passages, 
behind the uvula. It is used in the treatment of chronic catarrh, 
affecting the nasal passages, and pharynx or throat. Price, in box, 



366 MEDICAL AND SURGICAL COMPANION. 

$5.00. The Medicated Vapor Inhaler and Naso-Pharyngeal Syr- 
inge will be forwarded, by Express, to any part of the country, on 
receipt of price. 

MEDICINE CHEST. 

It is well for every family, residing far from a physician, and all 
travellers, seamen, miners, &c, to have some kind of a Medicine 
Chest, containing such articles as are most useful in cases of sudden 
sickness or accident. 

The chest may be made of any kind of wood, and of any size and 
form which the party ordering it may like. Any trunk-maker, 
cabinet-maker, or carpenter can construct it, if you give him a clear 
idea of what size you prefei, and what you wish it to contain. One 
two feet long, fifteen inches wide, and one foot deep, will contain 
about all which will be necessary. If it has a lock-drawer at the 
bottom, divided into two or more compartments, it will be found 
very convenient. The body of the chest, above the drawer, should 
be divided into large and small compartments, for vials, packages, 
utensils, &c. All liquids should be kept in glass stoppered vials ; 
powders and ,salts in " salt-mouths," with glass stoppers. Ointments 
may be kept in earthen or porcelain pots, or tin boxes. 

The chest should be supplied with the following articles, viz. : — 

1. Apothecaries' Scales and Weights, in box. 

2. A two-ounce Glass Graduated Measure. 

3. A Medicine Glass, for measuring teaspoonfuls and tablespoon- 
fuls of liquids. 

4. A Porcelain slab, about six by eight inches in size, on which 
ointments and pills can be made. 

5. A one-half pint Glass Mortar and Pestle. 

6. Two Apothecaries' Knives (spatulae), for mixing ointments, 
making pills, spreading plasters, and dividing powders. 

7. A one-half pint glass tunnel or funnel. 

8. A Davidson Syringe. 

9. A hard-rubber Ear Syringe. 

10. A No. 7 Elastic Male Catheter. 

11. A Silver Female Catheter. 

12. Three suture needles, — large, small, and medium size. 

13. A lancet. 

14. Artery forceps. 



RECIPES. PRESCRIPTIONS. MEDICINES. 367 

15. Small Scissors. 

16. Lint. 

17. Sponge. 

18. Adhesive Plaster. 

Now we come to speak of the medicines necessary to complete 
the outfit. The variety and quantities necessary will depend 
something upon the ease with which the stock can be replenished. 
I will refer by numbers, to such medicines in the Recipe Depart- 
ment, as I deem the most essential for completing the outfit. 1, 4, 
5, 6, 7, 13, 20, 21, 22, 26, 35, 44, 49, 50, 51, 59, 62, 63, 65, 67, 71, 
72, 74, 75, 76, 78, 80,81, 84, 85, 86, 87, 89, 106, 109, 113, 115, 119, 
120, 123, 135, 137, 138, 146, 147, 153. Take as many more as you 
desire, or as your chest will contain. They should all be correctly 
labelled, and the uses and doses should be plainly stated. When 
doses have been mentioned in the preceding pages, they have been, 
as before remarked, for adults, unless otherwise stated. 



368 MEDICAL AND SURGICAL COMPANION. 



CHAPTER II. 

DIETETIC PREPARATIONS AND BEVERAGES FOR 
THE SICK. 

The importance of an acquaintance with those preparations of 
diet, peculiarly designed for patients during disease and convales- 
cence, is so obvious, that it requires little or no comment. 

The rules to be observed in giving nourishment to the sick, will 
generally present themselves ; but there is one in particular which 
should not be overlooked. In all low diseases care should be 
taken not to give too much at once, but frequently to repeat a small 
proportion. The lapse of a very short time without food will fre- 
quently, in cases of great prostration, reduce the patient very low, 
and may endanger his life. This rule applies to acute diseases. 

Barley Water. 

Take of Pearl Barley, 2 ounces. 

Boiling Water, . . . • .2 quarts. 

Before adding the boiling water, let the barley be well washed. 
Then boil it to one half, and strain the liquor. A little lemon-juice 
and sugar may be added, if desirable. 

To be taken freely in fevers and inflammatory diseases. 

Rice Water. 

Take of Rice, 2 ounces. 

Let it be well washed, and then add to it 

Water 2 quarts. 

Boil for an hour and a half, and then add as much sugar and 
nutmeg as may be required. To be taken freely in fevers. 

Flaxseed Tea. 

Take of Flaxseed, 1 ounce. 

Boiling Water, 1 pint. 

Pour the boiling water on the unbruised seed, cover the vessel, 



RECIPES. PRESCRIPTIONS. MEDICINES. 369 

and let it stand near the fire for an hour or two. The seeds must 
not be crushed or boiled, lest the oil in the interior be extracted. 
Having strained the infusion, add to it a little lemon-juice, if no 
contra-indicating circumstances exist. Flaxseed is a mild demul- 
cent, and is much used in diseases of the throat, chest, and urinary 
passages. 

Toast Water. 
Cut a slice half an inch thick, from a loaf of stale bread ; remove 
the crust, and carefully toast the slice on both sides. Place the 
toast and a small piece of orange or lemon-peel in a suitable vessel, 
add a pint of boiling water, cover the vessel, and, when cold, strain 
off the water. This forms an agreeable drink in fevers. 

Gum Arabic Water. 

As an article of diet, the proper proportions are one ounce of 
gum arabic to a pint of boiling water. The solution is allowed to 
cool before it is used. 

Gum arabic is very nutritive, and life can be sustained on it 
alone for some time. 

Lemonade. 

Take of Fresh Lemon Juice, .... 4 ounces. 
Fresh and very thin Lemon Peel, . . \ ounce. 

White Sugar, 4 ounces. 

Boiling Water, 3 pints. 

Let them stand until cold, then strain off for use. When em- 
ployed in fevers, a little sweet spirit of nitre is sometimes added, 
but I prefer to give them separately. 

When fresh lemon-juice cannot be procured, an excellent lemon- 
ade can be prepared from lemon syrup, made as follows : Dissolve 
ten drachms of tartaric or citric acid, and eight pounds of loaf sugar, 
in a gallon of water. Then rub from half a drachm to a drachm of 
fresh oil of lemon with a portion of the syrup, and afterwards care- 
fully mix it with the remainder. 

Lemonade, when freely taken, sometimes produces pain in the 
bowels. It must, therefore, be used with some reserve as a daily 
drink. 

Oatmeal Gruel. 

Rub two ounces of oatmeal into a paste with a little cold water, 
and then gradually add a quart of boiling water. Let the whole boil 



370 MEDICAL AND SURGICAL COMPANION. 

fifteen minutes, stirring frequently. Add a little salt, remove from 
the fire, and sweeten to taste. 

If no reason to the contrary exists, the flavor of the gruel is much 
improved by adding some nutmeg, with wine or brandy, or a few 
raisins. 

Indian Meal Gruel. 

Indian meal gruel is made in the same manner as oatmeal gruel. 
It is necessary, however, to boil it a few minutes longer. 

Mice Flour Gruel. 

Take of Ground Rice, 1 ounce. 

Cinnamon, 1 drachm. 

Boiling Water, 1 quart. 

Having rubbed the rice flour into a paste with a portion of the 
water, add the remainder gradually, and boil for forty minutes, 
adding the powdered cinnamon near the conclusion. Strain and 
sweeten. Wine may be added if necessary. 

Panada. 

Take of Wheat Bread, 1 ounce. 

Powdered Cinnamon, .... 1 drachm. 

Water, 1 pint. 

Boil them until well mixed, then add a little grated nutmeg and 
sugar. Wine or butter may be added, if desirable. 

Sago. 

Take of Sago, 2 tablespoonfuls. 

Water, 1 pint. 

Boil gently until it thickens, frequently stirring. Wine, sugar, 
and nutmeg may be added, according to circumstances. 

Tapioca Jelly. 

Take of Tapioca, 2 tablespoonfuls. 

Water, 1 pint. 

Boil gently for an hour, or until it assumes a jelly-like appear- 
ance. Add sugar, wine, and nutmeg, with lemon juice, to suit the 
taste of the patient and the nature of the case. 

Arrowroot. 

Take of Arrowroot, 1 tablespoonful. 

Cold Water, sufficient. 

Boiling Water, \ pint. 



RECIPES. PRESCRIPTIONS. MEDICINES. 371 

Mix the arrowroot with just enough cold water to soften the 
lumps, then pour on the boiling water, and stir constantly, until 
the solution is gelatinous and transparent. Sweeten to the taste, 
and grate in a little nutmeg. 

Maizena, or Com Starch. 

To one quart of boiling milk add, gradually, four tablespoonfuls 
of the starch, previously rubbed into a paste with a little cold milk ; 
then add some salt, and boil for five minutes, stirring briskly. 
Sweeten to the taste, and flavor with essence of vanilla, lemon, or 
orange. Then set aside to cool. 

Boiled Flour. 

Take of fine Flour, 1 pound. 

Tie it up in a linen cloth as tight as possible, and after frequently 
dipping it in cold water, dredge the outside with flour till a crust 
is formed round it, which will prevent the water soaking into it 
while boiling. It should then be boiled until it becomes a dry 
mass. Two or three tablespoonfuls of this may be grated, and pre- 
pared in the same manner as arrowroot, for which it forms an ex- 
cellent substitute. 

Vegetable Soup. 

Take one turnip, one carrot, two potatoes, and one onion. Let 
them be sliced, and boiled in one quart of water for an hour. Add 
as much salt as is agreeable, flavor with a small portion of pot- 
herbs, and pour the whole upon a piece of dry toast. This prepa- 
ration forms an agreeable substitute for animal food, and may be 
given when the latter is inadmissible. 

Mutton Broth. 

Select two tender mutton chops, put them into a saucepan, add 
one quart of cold water and a little salt, cover the pan and cook 
slowly for two hours. Then skim off all the fat, and add one table- 
spoonful of rice, one white potato, one turnip, and a little parsley, 
chopped fine. Simmer for three quarters of an hour, then pour 
into a bowl, and remove the chops, and all of the remaining fat. 
This broth is nutritious and palatable. 



372 MEDICAL AND SURGICAL COMPANION. 

Beef Tea. 

Take of Lean Beef, cut into shreds, . . .1 pound. 
Cold Water, 1 quart. 

Heat slowly to the boiling point, and then boil twenty minutes, 
taking off the scum as it rises. Strain the liquor, and add salt ac- 
cording to the taste. This preparation is more nourishing than 
ordinary broths, and very palatable. 

Liebig's Beef Tea. 

" One pound of lean beef, free of fat, and separated from the 
bones, in the finely chopped state in which it is used for mince 
meat, is uniformly mixed with its own weight of cold water, slowly 
heated to boiling, and the liquid, after boiling briskly for a minute 
or two, is strained through a towel, from the coagulated albumen 
and fibrine, now become hard and horny. Thus we obtain an 
equal weight of the most aromatic soup, of such strength as cannot 
be obtained, even by boiling for hours, from a piece of flesh." This 
is to be seasoned to taste. 

Essence of Beef. 

Put a sufficient' quantity of lean beef, sliced, into a porter-bottle 
to fill up its body, cork it loosely, or not at all, and place it in a 
pot of cold water, attaching the neck to the handle of the vessel, by 
means of a string. Boil for an hour and a half or two hours, then 
decant the liquid and skim it. 

To this preparation may be added spices, salt, wine, brandy, &c, 
according to the taste of the patient and nature of the disease. 

Calves' -Feet Jelly. 

Take a set of four feet, break them into 6mall pieces, add to 
them one gallon of water, and reduce by boiling to one quart. 
Strain, and when cold, skim the fat entirely off. Add to this the 
shells and whites of six eggs, well beaten, a pint of wine, a pound of 
loaf sugar, and the juice of four lemons, and let them be well 
mixed. Boil the whole for a few minutes, stirring constantly, and 
then pass the jelly through a flannel strainer. This forms a very 
nutritious article of diet for the sick and convalescent. 



RECIPES. PRESCRIPTIONS. MEDICINES. 373 

Blanc Mange. 

Boil one ounce of shred gelatine in a quart of milk, for a few 
minutes, stirring constantly. Sweeten to the taste, flavor -with 
peach-water or essence of vanilla, and strain into a mould. 

Chicken Water. 

Take one half of a chicken, divested of all fat, and break the bones ; 
add to this half a gallon of water, and boil for half an hour. Strain, 
and season with salt. A nutritious drink. 

Mucilage of Starch. 

Take of Starch, 1 ounce. 

Powdered Cinnamon, .... 1 drachm. 

Gum Arabic, 1 ounce. 

Boiling Water, 3 pints. 

Boil until reduced one third, and strain. The above may be 
taken for a common drink in dysentery. 

Mulled Wine. 

Take two drachms of bruised cinnamon, half a nutmeg, grated, 
ten bruised cloves, and half a pint of boiling water. Infuse one 
hour, strain, and add of hot port or sherry wine (or good domestic 
wine) one pint, and white sugar, one ounce. Mix. This is a mild, 
stimulant drink, used in convalescence from low forms of disease. 

Wine Whey. 

Heat half a pint of milk to the boiling point, and, when boiling, 
add a gill of sherry or Madeira wine. Let it boil again, and then 
remove from the fire, and let it stand a few minutes. Then 
remove the curd, pour the whey into a bowl, and sweeten it. A 
little sugar and nutmeg may be added if desired. This is a mild 
and very useful stimulant, and may be used in diseases where 
there is great debility ; the dose to be regulated by the circum- 
stances of the case : from a gill to a pint or more may be taken 
during the day. 



MEDICAL NOTICE. 



The undersigned, in addition to attending to gen- 
eral family practice, gives particular attention to the 
treatment of Diseases of the Air Passages and Lungs, 
— Chronic Catarrh, Chronic Bronchitis, Asthma, 
and Consumption, — making use of Inhalations of 
Medicated Vapors and Atomized Liquids, in connec- 
tion with other appropriate measures. 

Attention is also given to Female Complaints, Dis- 
eases of the Urinary and Genital Organs, Skin Dis- 
eases, Dyspepsia, Scrofula, Rheumatism, and all Chronic 
Diseases. 

Letters, inquiring in regard to treatment, &c, and 
containing a return postage stamp, promptly answered. 
Patients from a distance, when required to remain in 
the city for a short time, can readily obtain good board- 
ing places. 

OFFICE, No. 90 AVON STREET, 

(Leading from No. 262 Washington Street). 
Residence, 80 Cambridge Street. 

Office Hours — From 10 to 12, A. M., aiid 2 to 4, P. M. 
Sundays and Holidays, from 10 to 12, A. M. 

A. I. FENN, M. D. 
Boston, April, 1870. 

(374) 



INDEX. 



A. 

PAGE 

Abdomen, Enlargement of. . ... 190 

Abdomen, Wounds of, 242 

Abdominal Consumption, 159 

Abdominal Dropsy, 149 

Abortion, 195 

, 308 

t of the Liver, 139 

Accidents, 233 

Acid, Carbolic, Lotions of, . ... 355 

Acid, Gallic, Powders of, 346 

Acid, Nitric, 347 

Acne, 172 

Acute Rheumatism, 39 

Adhesive Plaster, 10 

Air Passages, Diseases of, ... . 71 

Alteratives 345 

Amaurosis, 272 

Amenorrhea, 186 

Ammonia, Carbonate of, 339 

Amputation, 257 

Amusements, 4 

Anaemia, 48 

Anaesthetics, 361 

Aneurism 316 

Angina Pectoris 107 

Animation, Suspended, 222 

Antacids, 347 

Antevcrsion of Uterus, 184 

Anthelmintics, 337 

Antispasmodics, 341 

Anus, Fissure of, 319 

Aphtha 113 



PAGE 

Apoplexy, 51 

Apothecaries' Weights and Meas- 
ures, 10 

Arrowroot, 370 

Ascites, 148 

Asthma, 87 

Asthma, Hay, 89 

Astringents, 346 

Astringents for external Use, . . . 347 

B. 

Baldness, 176 

Balanitis, 282 

Balsam of Copaiba Mixtures, . 332, 333 

Barbadoes Leg, 175 

Barber's Itch, 174 

Baths, 357 

" Alkaline, 358 

" Cold, 357 

" Warm, 358 

Barley Water, 368 

Beds 5 

Beef Tea, 372 

" Liebig's, 372 

Bees, Stings of, 244 

Bite, from Mad Dog, 243 

" Mosquitos, 244 

" Rattlesnake 243 

Bladder, Diseases of, 151 

" Inflammation of, .... 157 

'• Irritability of, 156 

" Paralysis of. 158 

Blanc Mange, 373 

Bleeding, how to arrest, 234 

(375) 



376 



Bleeding from Nose, 256 

Blistering Plaster, 348 

Blisters, 348 

Blood, Diseases of, 110 

" Letting, 265 

" Spitting of, 104 

" Vessels, 12 

Bloody Urine, 154 

Blue Disease, 109 

Blue Pill, 361 

Boat Accidents, 224 

Boils, 321 

Bones, Brittleness of, 314 

" Diseases of, 313 

" Softening of, 314 

Boiled Flour 371 

Bowels, Inflammation of, 124 

" Obstruction of, 135 

Brain, Compression of, 256 

" Concussion of, 255 

" Inflammation of, 49 

Bright's Disease, 152 

Broken Bones, 244 

Bronchitis, Acute 85 

Bronchitis, Chronic 86 

Bruises 253 

Bubo, 292 

Buchu Mixture, 332 

Bunion, 325 

Burns and Scalds, 254 

c. 

Calomel, 361 

Calves' Feet Jelly, 372 

Cancer, 317 

" of Stomach 123 

" of Womb, 182 

" of Liver, 141 

Canker, 113 

Caries, 313 

Carminative Drops, 341 

Castor Oil, 9, 330 



Cataract 272 

Catarrh, Acute, 71 

Catarrh, Chronic, 72 

Cathartics, 330 

Carbolic Acid Lotions, 355 

Care of the Feet, 326 

Carbuncle, 322 

Caustics, 347 

Chalk Mixture, 362 

Chest, Wounds of, 241 

Chicken Pox 34 

Chilblains, 322 

Childhood, Diseases of, 199 

Chloride of Soda, Injection of, . . 351 

Chloroform, 364 

" Liniment, 354 

Chlorosis 48 

Cholera, Asiatic, 131 

" Infantum, 214 

" Morbus, 130 

Chronic Peritonitis, 148 

Chronic Kheumatism, 41 

Cimicifuga, Mixture of, 342 

Cleanliness, 1 

Cleanliness and Clothing of In- 
fants, 203 

Clergyman's Sore Throat, .... 74 

Clothes catching Fire, 225 

Clothing, 1 

Cod Liver Oil 345 

Cold, 5, 71 

Colic, 126 

Collapse, 233 

Cologne, 360 

Compound Accidents, , 257 

Compound Cathartic Pills, ... 9, 330 

Composition Powder, 362 

Compression of the Brain, .... 256 

Concussion of the Brain, 255 

Consumption, Abdominal, .... 149 
Consumption, Pulmonary, .... 94 
Convulsions, 211 



377 



Copaiba, 332,333 

Corns, 325 

Corn Starch, 371 

Cough Mixtures, 335 

Coup de Soleil, 52 

Cow Pox, 33 

Croton Oil Liniment, 349 

Croup, Membranous, 77 

Croup, Spasmodic, 79 

Crusta Lactea, 167 

Cupping, 267 

Cyanosis, 109 



D. 

Dandruff, , 

Delirium Tremens, . . . 

Dementia, , 

Dentition, Disorders of, 



. . . 171 
. . . 53 
. . . 57 
20S, 211 



Diabetes, 155 

Diaphoretics, 333 

Diarrhoea, 128 

Diarrhoea, Infantile, 214 

Diarrhoea Mixtures, 363 

Digestion, 1 

Digestion, Time required for, ... 3 

Dimness of Vision 272 

Diphtheria 79 

Directions for passing Catheters, . 268 
Diseases, General Eules for treat- 
ing, 14 

V of the Air Passages and 

Lunge, 71 

" of the Bladder 151 

" of the Blood, 110 

" of the Bones 313 

" of the Hair, 175 

" of the Heart, 106 

" of the Kidneys 151 

" of the Liver, 139 

" of the Nervous System, . 49 
" of the Organs of Diges- 
tion, 113 



Diseases of the Spleen, .... 139, 144 

" of Women, 178 

" of Infancy and.Childhood, 199 
" of the Prostate Gland, . . 302 

" of the Hip Joint, 315 

Diseased and Decaying Food, . . .232 
Displacements of the Uterus, . . .183 

Dislocations, 250 

" of Lower Jaw, .... 250 

" of Collar Bone, .... 250 
" of the Shoulder, ... 250 

" of the Elbow, 251 

" of the Wrist, 251 

" of the Fingers, . . . . 251 

" of the Hip, 251 

" of the Ankle 252 

" of the Bones of the 

Foot 252 

Diuretics, 332 

Domestic Measure, 11 

Doses of Medicine adapted to differ- 
ent Ages, 11 

Dover's Powder, 333, 340 

Drink, 1 

Dropsy, Abdominal, 148 

Dropsy of the Scrotum, 300 

Drowning, 222 

Dysentery, 128 

Dysmeuorrhoea, 187 

Dyspepsia, 115 

Ear, Discharge from, . .... 275 

" Inflammation of, 974 

" Removal of Foreign Bodies 

from 262 

" Washos for 350 

" Wounds of 241 

Earache, 273 

Ecthyma 160 

Eczema, 164 

Egg Nog, 339 



378 



Elephant Leg 175 

Elixir of Pepsin 344 

Emetics, 329 

Emmenagogues, 337 

Endocarditis, 109 

Enlargement of the Abdomen, . . 190 
" of the Prostate Gland, 304 

" of the Spleen, .... 144 

Epilepsy, 64 

Epispastics, 348 

Epistaxis, 256 

Epsom Salts, 330 

Erysipelas, 160 

Essence of Beef, 372 

Essence of Peppermint, 9 

Exercise and Sleep of Infants, . . 205 

Expectorants, . • 335 

Eye, Removal of Foreign Bodies 

from, 264 

Eye Washes, 349 

F. 

Fevers 16 

Fever, Bilious 19 

" Hectic 30 

" Infantile, 219 

" in General, 16 

" Intermittent, 18 

" Remittent, 19 

" Simple Inflammatory, ... 17 

" Eruptive 31 

" Typhoid, 22 

" Typhus,' 26 

" Yellow, 20 

Feet, Care of, 326 

Felon, 322 

Fissure of the Anus, 319 

Fistula in Ano, 320 

Flaxseed Tea, 368 

Flannel 4 

Fluor Albus, 178 



Fomentations, 358 

Food 1 

Food, Diseased and Decaying, . . 232 

Food of Infants, 199 

Fractures, 244 

Fracture of Bones of Nose, .... 245 

" of Lower Jaw, 245 

" of Collar Bone, 245 

" of Arm, 246 

" of Fore-arm, 246 

« of Wrist, 247 

" of Hand 247 

" of Fingers 247 

" of Ribs, 247 

" of Thigh, 248 

" of Knee-pan 248 

" of Leg, 249 

" of Bones of Feet, .... 249 

" of Toes, 250 

Frost Bite, 323 

Q. 

Gallic Acid, Powders of, 346 

Gangrene, 237 

Gargles and Mouth Washes, . . . 352 

Gastritis 119 

Gleet, 283 

Glycerine, 10, 59 

Glycerine Lotions 354 

Gonorrhoea, 277 

" in the Female, .... 283 
Gonorrhoeal Inflammation of the 

Eyes, 282 

Gout 43 

Gravel, 305 

Gum Arabic Water 309 

H. 

Hair, Blanching of, 176 

" Diseases of, 175, 176 

" Gray, 176 



379 



Hair Oils, 359 

Hanging, . . • 224 

Hardtaack, Mixture of, 346 

Hay Asthma, 89 

Headache, 59 

Heart, Diseases of, 106 

Hectic Fever, 30 

Hemiplegia 60 

Hemorrhage, Methods of Arrest- 
ing 234 

Hernia 257 

Herpes, 164, 175 

Hints to Invalids Travelling, ... 6 
Hints to Travellers in Health, . . 4 

Hip Joint, Disease of, 315 

Hoffman's Anodyne, &c, 342 

Hordeolum, 271 

Hot Drops 362 

Hydrophobia 69 

Hydrocele, 300 



I. 



Icterus, 

Idiocy, 

Impotency, 

Impetigo, 

Incontinence of Urine, . . 

Indian Meal Gruel, 370 

Infants, Food of, 199 

M Management of, 199 

Infantile Fever, 219 

Inflammation, 236 

" Terminations of, . . 236 

" of the Bladder, . . 157 

" of the Bowels, . . 124 

" of the Ear, .... 274 

" of the Eye, 271 

" of the Intestines, . 124 

" of the Prostate 

Gland, ..... 304 



Inflammationjof the Stomach, . . 119 
" of the Throat, ... 114 

«« of the Tongue, . . 113 

" of the Uterus, ... 181 

Influenza, 82 

In-growing Toe Nail, 326 

Inhaler, 365 

Inhalation, 336 

Inhaling Preparations, .... 343, 344 

Injections 331 

" for the Urethra, .... 350 

" for the Vagina, 351 

" of Salt Water, 331 

11 of Warm Water, .... 331 

" Purgative, 331 

Insanity, 54 

Insanity, Varieties of, 55 

Intermittent Fever, 18 

Iodine Paint, 349 

Ipecac, Powdered, 9, 329 

" Wine of, 9, 329 

Iron, Ammonio-Citrate of, .... 343 
«• and Quinine, Citrate of, . . . 344 
" Preparations of, ... . 343, 344 
" Tincture of Chloride of, . . . 343 

" Wine of, 344 

Itch, 168 

" Barber's, 169 

Itching — Prurigo, . . . ;■'-. . . .169 
" of the Vulva 178 

J. 
Jaundice, 142 

K. 

Kidneys, Diseases of, 151 

»' Granular Degeneration of, 152 

" Inflammation of, 151 

Kine Pox, 33 

Kleptomania, 57 



L. 
Labor, 3 

" — Confinement, 191 

" Stages of, 191 

" Management of, 192 

Laudanum,) 8, 341 

Larynx, Acute Inflammation of, . 75 
" Chronic Inflammation of, 77 

Lead Palsy, 62 

Leeches, 267 

" how to apply, 267 

Leech Bites, to check bleeding 

from, 267 

Lemonade, 369 

Leprosy, 170 

Lepra Vulgaris, 170 

Leucorrhoea, 178 

" Chronic Vaginal, ... 180 

" Infantile, 181 

" Uterine 180 

Lichen, 169 

Liniment, Anodyne, 10 

" Croton Oil, 349 

" Volatile, 349 

Liniments, 'Washes, &c 359 

Lithotomy, 307 

Lithotrity 307 

Liver, Abscess of, 139 

" Cancer of, 141 

" Diseases of, 139 

" Inflammation of, 139 

Lochia, 195 

Locked Jaw, 68 

Long Sight, 270 

Lunar Caustic, 347 

Lung Fever, 92 

Lungs, Diseases of, 71 

Lupus, 173 



M. 

Maizena, 371 

Mania, 55 

" Puerperal, 55 

Measles, 35 

Measures, 10 

Medicated Vapor Inhaler 365 

Medicines, 8, 329 

Medicine Chest 366 

Membranous Croup, 77 

Menstrual Diseases, 186 

Menstruation, 185 

" Absence of, 186 

" Painful, 187 

" Profuse, 188 

" Vicarious, 1*9 

Mentagra, 171 

Mercurial Palsy, . . . % 62 

Milk Leg, 198 

" Punch, 339 

Mixture of Acetate of Potassa, . . 332 
" of Buchu and Uva Ursi, . 332 

" of Copaiba, 332 

Miscarriage 195 

Monomania 56 

Morphine Pills, 340 

Mortification, 237 

Mucilage of Starch, 373 

Mulled Wine, 373 

Mumps, 114 

Mustard, 330, 348 

Mutton Broth, 371 

Myopia, 270 

N. 

Narcotics, 340, 341 

Nasopharyngeal Syringe, .... 365 

Near Sight, 270 

Necrosis, 313 



381 



Nervous System, Diseases of, . . . 49 

Nettle Rash, 163 

Neuralgia, 70 

Nitrate of Silver, 347 

Nitric Acid, 347 

Nitro-Muriatic Acid Mixture, ... 361 

Nitrous Oxide, 364 

Nose, Bleeding from, 256 

" Wounds of, 241 

" Removal of Foreign Bodies 

from, 262 

Nurse, 15 

o. 

Oatmeal Gruel, 369 

Obstruction of the Bowels 135 

Ointments, 355 

Ointment, Basilicon, 355 

" Compound Sulphur, . . 355 

" Simple Sulphur, .... 356 

« Simple, 10, 355 

Onion Poultice, 348 

Ophthalmia, 271 

Opium, Camphorated Tincture of, . 8 

" Liniment, 353 

" Pills, 340 

" Tincture of, 8 

Otalgia 273 

Otorrhoea, 275 

Ovarian Dropsy, 149 

" Tumors, 149 

P. 

Pain in the Stomach, 117 

Palpitation 106 

Palsy, 60 

Panada, 370 

Paralysis, 60 

" of Bladder, 158 

" Shaking, 63 

Paraplegia 61 



Paraphymosis, 307 

Paregoric, 8, 341 

Parsley Root, ' 332 

Pemphigus, 165 

Pennyroyal, 334 

Pepper, Black 348 

Peppermint, Essence of, 19 

Pepsin, Elixir of, 344 

Pericarditis 108 

Peritonitis, Chronic, 148 

Pertussis 83 

Peruvian Bark, CompoundJ Tine- ■ 

ture of, 345 

Phlegmasia Dolens, 198 

Phthisis, 94 

Phymosis, 307 

Piles, 319 

Pills, Compound Cathartic, ... 9, 330 

Pityriasis, 171 

Pneumonia, 92 

Plaster, Adhesive 10 

Pleurisy 90 

Poisoned Wounds, 243 

Poisoning, 226 

'• from Arsenic, 227 

" " Alcoholic Liquors, 227 

" " Alkalies 227 

" " Corrosive Subli- 
mate, 228 

" " Mineral Acids, . . 228 

" " Oxalic Acid, . . . 228 

" " Prussic Acid, ... 228 

" " Strychnia, . . . . 228 

" " Lead, 228 

" " Opium, &c, ... 226 

Polypus, 317 

" of Uterus, 182 

Porrigo, 168 

Potassium, Iodide of, 345 

Poultices, 356 

Pregnancy 189 



382 



Pregnancy, Duration of, 190 

Premature Labor, 195 

Prolapsus Uteri, 183 

Prostate Gland, Diseases of, ... 302 
" " Enlargement of, . 304 

" " Inflammation of, . 301 

Frostatorrhcea, 303 

Prostration, 233 

Prurigo, 109 

Psoriasis, 171 

Puerperal Mania, 55 

Pulse, 12 

Pure Air, 1 

Purpura, 112 

Pyrosis 118 

Q. 

Quickening, 190 

Quinine Mixture 300 

R. 

Recipes, 329 

Recreation 4 

Remittent Fever, 19 

Rest, 3 

Retroversion of the Uterus, . . . . 181 

Rheumatism, Acute, 39 

" Chronic, 41 

Bhubarb, Tincture of, 10 

Rice Flour Gruel, 370 

Rice Water, 308 

Rickets, 311 

Ringworm, 164 

Rochelle Powders, 331 

Roseala, 162 

Rose Rash, 162 

Rubefacients, 348 

Rupia, 166 

Ruptures, 257 

" Irreducible, 258 

" Reducible, 257 

" Strangulated, 259 



S. 

Sage, 334 

Sago, 370 

Salt Rheum, 171 

Salts, Epsom, 330 

Sarsaparilla Mixture, 345 

Scabies, 168 

Scalds, 254 

Scald Head, 168 

Scaly Leprosy, 170 

Scarlet Fever, 36 

Scarlatina, 31, 36 

Sciatica 43 

Scrofula, 46 

Scrotum, Dropsy of, 300 

Scurvy, 110 

Sea Sickness 225 

Seidlitz Powders, 331 

Shaking Palsy, 63 

Shingles, * 164 

Shock, 233 

Sick Room, 15 

Simple Ointment, 10, 355 

Simple Inflammatory Fever, ... 17 

Skin, Diseases of, 170 

Sleep of Infants, 205 

Small Pox, 31 

Soda, Bicarbonate of, 347 

Sore Throat, 114 

Spasmodic Croup 79 

Spermatorrhoea, 301 

Spitting of Blood, 104 

Spleen, Diseases of, 144 

" Enlargement of, 144 

Sprains, 252 

Squinting, 273 

Stimulants, 338, 339 

Stings of Bees, Wasps, &c., . . . 244 

Stomach, Ulcer of, 121 

Stoughton's Elixir, 345 

Strabismus 273 



Stye, 271 

St. Anthony's Fire, 170 

Sun Stroke, 52 

Surgery, 233 

Surgical Injuries, 233 

Suspended Animation, 222 

Sweating Drops, 334 

Sweet Spirit of Nitre, 332, 334 

Swelled Testicle, 299 

Sycosis, 174 

Syphilis, 277,284 

" Secondary, 294 

" " Treatment of, . 294 

" Tertiary, 295 

" Treatment of Primary, 

288, 290 
Syphilitic Disease in Children, . . 296 
Syrup of Iodide of Iron, 345 

T. 

Tabes Mesenterica 150 

Tannin, Pills of, 346 

" Solution of, 360 

Tapioca, 370 

Tetanus, 68 

Teeth, how to Preserve, 327 

Teething, 207 

" Disorders of, 207 

Testicle, Inflamed, 299 

Tetter, 164, 171 

The Nurse 15 

The Sick Room, 15 

Thrush 113 

Throat, Removal of Foreign Bodies 

from, 261 

" Wounds of, 241 

Thunder Storm, Cautions in regard 

to, 232 

Tincture of Chloride of Iron, . . .343 

" of Iodine, 349 

" of Rhubarb, • 10 



Toast Water, 369 

Toothache Drops, 358 

Tooth Powders 359 

Tonics, 343 

Toe Nail, In-Growing, 326 

Tongue, Inflammation of, 113 

Travellers, Hints to, 4, 6 

Trichina Spiralis, 229 

Trichiniasis, «229 

Tumors, 182, 316 

Typhoid Fever, 22 

Typhus Fever 26 

u. 

Ulcers, 310 

" Carious, 312 

" Fungous, 311 

" Healthy, 310 

" Indolent, 311 

" Inflamed, 310 

" of Stomach, 121 

" Sloughing, 311 

" Varicose, 312 

Urethra, Injections for, 350 

" Stricture of, 297 

Urine, Bloody, 154 

Urticaria, 163 

Uterus, Ante version of, 1S4 

" Displacements of, ... . 183 
" Inflammation of, .... 181 

" Retroversion of, 1S4 

" Tumors, Polypus, and 

Cancer of, 182 

UvaUrsi Mixture, 332 

V. 

Variola 31 

Varioloid, 33 

Vaccination, 34 

Vaccinia, 33 

Varicella 31 



384 



Varicocele, 300 

Vaginal Injections, 351 

Vegetable Soup, 371 

Ventilation, 1 

Venereal Diseases, 277 

" "Warts 293 

Ver.itum Viridc, 363 

Volatile Liniment, 349 

Vomiting of Blood, 118 

w. 

"Water Brash 118 

Water, Change of 5 

" Dressings, 357 

" in the Ilead, 50 

"Warts 324 

" Venereal 293 

"Wasps, Stings of, 244 

"Weaning, 201 

"Wen, 324 

"Weakness of Vision, 270 

Weights and Measures 10 

"Whites, 178 

"Whitlow, 323 

Whooping Cough 83 

"Wine of Ipecac, 329 



Wine Measure, 

" Whey 

Wolf, 

Womb, Inflammation of, 

" Tumors of, &c, 

Worm Medicines 



, . . 11 
339, 373 
. . . 173 
. . . 181 
. . . 182 
337,338 







.233 




' Contused and Lacerated 


240 






.237 




' of Abdomen, 


.242 




1 of Chest, 


. 241 




' of Ear and Nose, . . . 


.241 






. ?43 






.240 




' of Tendons, 


. 243 




' of Throat, 


.241 




' Poisoned, 


.243 




' Punctured, 


.239 


Y. 




Yellow Fever, 


. 2* 



z. 

Zinc, Ointment of Oxide of, . . . .356 



